Difference between revisions of "MIPS"
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'''Performance Score''' - There are two options for reporting performance score measure, based on 2014 CEHRT Edition or 2015 CEHRT Edition | '''Performance Score''' - There are two options for reporting performance score measure, based on 2014 CEHRT Edition or 2015 CEHRT Edition | ||
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Revision as of 16:25, 30 May 2018
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MACRA repealed the Sustainable Growth Rate formula and created the Quality Payment Program.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
- < = 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 measure 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 |
*** Exemptions: ePrescribing<100, HIE<100 transfer of care
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: l 2 high-weighted activities l 4 medium-weighted activities l 1 high-weighted activity and 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: l 1 high-weighted activity l 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 |
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 |
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