Which MIPS path is right for you?
By: Karen Knecht | January 26, 2017
In 2017, clinicians have a few options for complying with the Merit Based Incentive Payment System under MACRA.
In our previous post, we introduced the framework for the new Quality Payment Program (QPP) of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Here we look deeper at the Merit-based Incentive Payment System (MIPS) pathway, which the Centers for Medicare & Medicaid Services (CMS) estimates will achieve an 80 to 90 percent participation rate in the 2017 transition year.
Participation in MIPS can start on January 1, 2017 or by October 2, 2017 and the first payment adjustments are effective January 1, 2019. Eligible clinicians (ECs) will have three options in 2017 for MIPS based on submission of data for three performance categories – quality, improvement activities, and advancing care information (ACI). The cost category is based on administrative claims data, it does not require submission, and it is not weighted for the first year.
Clinicians seeking to participate in the first year of the Quality Payment Program have a few options to choose from, which Andy Slavitt, CMS acting administrator, outlined in this recently published blog.
The size of payment adjustments for any of these options will depend on how much data is submitted and the quality results. It is also important to note that if no data is submitted in 2017, eligible clinicians will receive a negative four percent payment adjustment.
Health information technology (HIT) is a key component of MACRA as it enables participation in the QPP. Under MIPS, CMS encourages reporting from Certified EHR Technology (CEHRT) or Qualified Clinical Data Registries (QCDRs). Bonus points are also available for end-to-end reporting, which uses automated software to aggregate measure data, calculate measures, perform filtering of measurement data, and submitting data electronically.
Through MIPS, CMS will collect and evaluate data related to four performance categories: Quality, ACI, improvement activities, and cost. Each category has a variety of measures that will be considered and weighted according to their value. This combination of measures will determine the clinician’s final score.
With so many measures and variable weighting structures, getting ready for MIPS may feel overwhelming. Organizations that don’t feel prepared to take on MIPS, should seek out help from experts in the field to create an implementation plan, and look for opportunities to engage with CMS about the performance metrics and how to best position themselves for a pay-for-value driven future.