MIPS
MIPS - Merit Based Incentive Payment System
MACRA repealed the Sustainable Growth Rate formula and created the Quality Payment Program. The Quality Payment Program changes the way Medicare pays clinicians and streamlines multiple quality programs. There are two options to choose from based on practice size, specialty, location or patient population. These are MIPS and APM (Advanced Alternative Payment Models). Most clinicians will be subject to MIPS unless they are in their 1st year of Part B participation, become QPs through participation in Advanced APMs, or have low volume of patients.
Who Does MIPS Affect? Medicare Eligible Clinicians
- Physicians
- Physician Assistants
- Nurse Practioners
- Clinical Nurse Specialists
- Certified Nurse Anesthetists
- Group that include such clinicians
CMS has provided a tool to see if you qualify for MIPS. Go to: https://www.cms.gov/Medicare/Quality-Payment-Program/Lookup-Tools/Lookup-tools.html
EXCLUSIONS
- < 30k Part B
- < = 100 Medicare Patients
MIPS has 4 Performance Categories
- Quality (PQRS) – formerly Physician Quality Reporting System (30%)
- Cost (VM) – formerly Value-Based Modifiers (30%)
- ACI(MU) – formerly MU (25%)
- Process Improvements (15%)
MIPS Reporting Periods - 2017
| PATH 1 | PATH 2 | PATH 3 | |
|---|---|---|---|
| Requirements | Report on 1+ quality measures | IA: 90 days | IA: 90 days |
| Report on 1+ IA measure | ACI: 90+ days, less than 1 year | ACI Full year | |
| Report on All Base ACI measures | Quality: 90+ days, less than 1 year | Quality: Full year | |
| Outcomes | No penalty | No penalty | No penalty |
| No Incentive | Proportion of potential incentive | Full potential incentive |
*** The more measures you report, the higher your score.
MIPS Reporting Periods - 2018
| PATH 1 | PATH 2 | ||
|---|---|---|---|
| Requirements | IA: 90 days | IA: 90 days | |
| ACI: 90+ days, less than 1 year | ACI: Full year | ||
| Quality: Full year | Quality: Full year | ||
| Outcomes | Proportion of potential incentive/penalty | Full potential |
*** The more measures you report, the higher your score.
MIPS Scoring
MIPS Score will be determined by four Composite Performance Scores:
- Quality – formerly PQRS measure (six or 15)
- Cost – Formerly Value Based Modifiers
- User of Health IT – formerly Meaningful User measure, now called ACI
- Better Process – Improvement Activities (IA) new program
For additional information on scoring visit: https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/MIPS-Scoring-101-Guide.pdf
Quality Category
Choose 6 measure to report (was 9 with PQRS) Groups using web interface report 15 measures Each measure is worth 0-10 points (proportionally) Translates into 60% of MIPS score (year 1)
Cost Category
Claims based calculation, no reporting necessary 10 episode specific measures Each measure worth up to 10 points (based on cost efficiency, 20 patient sample min. for ea measure) Score is based on average performance across all calculated measures No weight in 2017, but results still reported to participants
IA Category - Focused on care coordination, beneficiary engagement, and patient safety
Can earn up to 40 points
Groups of >15 will receive 10 points for Medium weighted activities, 20 points for High weighted activities. Pick any of these:
2 high-weighted activities
4 medium-weighted activities
1 high-weighted activity
2 medium-weighted activities
Groups of <15 will receive 20 points for Medium weighted activities, 40 points for High weighted activities. Pick either of these:
1 high-weighted activity
2 medium-weighted activities
For additional information on IA – Improvement Activities visit: https://qpp.cms.gov/mips/improvement-activities
ACI – Advance Care Information – Base Score, Performance Score, and Bonus Score make up the ACI performance score.
Base Score 50% of ACI - All or nothing
| Option 1 | Threshold | Option 2 | Threshold |
|---|---|---|---|
| Security Risks | Yes | Security Risk Analysis | Yes |
| E-prescribing | >=1 pt/event | E-presribing | >=1 pt/event |
| Provide patient access | >=1 pt/event | Provide patient access | >=1 pt/event |
| Send summary of care | >=1 pt/event | Send summary of care | >=1 pt/event |
| Request/accept summary of care | >=1 pt/event |
***Exemptions: ePrescribing < 100, HIE < 100 transfer of care"""
Performance Score - There are two options for reporting performance score measure, based on 2014 CEHRT Edition or 2015 CEHRT Edition
| 2014 CEHRT = Report up to 9 ACI Measures | 2015 CEHRT - Report up to 7 ACI Measures |
|---|---|
| Provide Patient Access | Provide Patient Access |
| Patient-specific education | Health information exchange |
| View, download, and transmit VDT | View, download, transmit |
| Secure messaging | Patient-specific education |
| Patient generated health data | Secure messaging |
| Send summary of care | Medication reconciliation |
| Request/accept summary of care | Immunization registry |
| Clinical information reconciliation | |
| Immunization registry reporting |
See Advancing Care Information Fact Sheet on: https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/Advancing-Care-Information-Performance-Category-Fact-Sheet.pdf
Bonus Score - up to 5% bonus score
| Option 1 | Option 2 |
|---|---|
| Syndromic Surveillance Reporting | Syndromic Surveillance Reporting |
| Electronic case reporting | Specialized registry reporting |
| Public health registry reporting | |
| Clinical data registry |
*** 10% bonus can be earned by using CEHRT to perform certain improvement activities
Scoring Summary
See Advancing Care Information Fact Sheet on: https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/Advancing-Care-Information-Performance-Category-Fact-Sheet.pdfhttps://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/MIPS-Measures-for-Primary-Care-Clinicians.pdf| Category | Number of Measure | Value of ea Measure | Potential Maximum Score | Max Score | MIPS Score % |
|---|---|---|---|---|---|
| Quality | 8 - 9 | 10 (measure scored proportionally) | 80 - 90 | 80 - 90 | 50% |
| CPIA | 90 | 10 or 20 | Hundreds | 60 | 15 |
| Cost | 40 | 10 (measure scored proportionally) | Score based on % achieved for ea measure | 10 | 10 |
| ACI - BaseCost | 6 | All or nothing | 80 | 100 | 25 |
| ACI - Performance | 8 | 10 (measure scored proportionally) | 80 | ||
| ACI - PHR | 3 | >0 = 1 | 1 |
See Advancing Care Information Fact Sheet on: https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/Advancing-Care-Information-Performance-Category-Fact-Sheet.pdf