MIPS a value-based reimbursement model activates under MACRA by the Centers for Medicare & Medicaid Services (CMS) to promote quality and cut down the cost of healthcare. It is an opportunity for medical professionals to choose quality over quantity, effectively deliver, and in return, earn some incentives. The positive payment adjustments await only those with scores higher than 15 out of a total of 100 points.
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For scores above 70, bonuses are likely to happen from the $500 million pool of money reserved only for the top performers. If you look closely, the program benefits all, the doctors, the insurance companies and most of all, the patients who are at the receiving end.
The Composite Performance Score (CPS) determines the overall performance of each practitioner when they report measures for four performance categories under the Quality Payment Program 2018.
Minimum Requirements of MIPS 2017
We saw the practical implementation of MIPS in 2017! The year 2017 was also the transition period to settle things down slowly and gradually. In 2018, the eligible practitioners are quite aware and implement the procedures to qualify for incentives, bonuses or simply to avoid penalties at the start of 2020.
There is a change in the set of rules for 2018. Each of the categories influencing the MIPS final score undergoes an increase in the number of measures. QPP 2018 is a chance for you to show brilliance in terms of quality of care and earn incentives along with a solid reputation in the healthcare industry.
Quality covers 60%, Improvement Activities (IAs) 25%, and ACI or meaningful use carries 15% of the total score. A MIPS Final Score of 3 or above would save them from negative adjustments in 2019. It included reporting on 1 Quality measure, 1 Improvement Activity or all the Advancing Care Information (ACI) measures.
It was only recently that CMS published the scores of 2017 on their QPP portal.
Basic Requirements in 2018
In MIPS 2018, the Quality covers 50%, Improvement Activities (IAs) 15%, Promoting Interoperability (ACI or meaningful use) 25%, and Cost, the new category, makes up to 10% of the final score.
In 2018, the rules are changed and the stakes are higher now. The EPs need 15 points to make it to the safe zone and avoid a higher penalty (up to 5% of the Medicare Part B payments) in 2020. To achieve this score, you must successfully attempt 2-3 Quality measures, 4 Improved Activities or perform all the ACI base measures.
MIPS Qualified Registry like P3Care only takes a few of your minutes to shortlist those measures.
Mathematical Side of MIPS
Quality holds significance as a performance parameter for MIPS 2018. It adds to the total score by assessing how well the practitioners perform measures in terms of their practice or their field of expertise. The practitioners review the list of measures and select only those best suited to their practice.
For specialists, there are specialty-specific measure sets. In 2017, there were 30 specialty measure sets. Some sets have fewer measures and some have more, but you have to complete only those related to your specialty. For sets containing more than 6 measures, you must cater to those 6 and complete an outcome measure or a high-priority measure, additionally.
Topped Out Objectives
There are 6 topped out Quality measures identified by CMS in 2018. The measures identified as ‘topped out’ means that the eligible physicians are no longer able to score more than 7 in them. Performance for these measures is usually high and completing them does not mean improvement in the quality of service.
Multiple Measure Options for Eligible Clinicians in 2018
Quality – CMS website displays 271 measures from which you can select six of your choice with one outcome measure or a high-priority measure.
Improvement Activities (IA) – Report up to 4 measures to achieve a score of 40 points in this category.
Promoting Interoperability (PI) – The category was Advancing Care Information (ACI) or meaningful use the year before. ECs must report all 4 base measures to achieve a maximum score. Select from among the seven measures.
Cost – Medicare Spending per Beneficiary (MSPB) is at stake here and it has zero measures for you to report. CMS will deduce the score itself by analyzing the claims data of the practitioner.
Hard Work Pays Off
Successful execution of all these performance categories can earn you 15 points and save you from the penalty in 2020. However, when you complete more than 6 or 7 measures along with a few outcome measures or high-priority measures, you make yourself eligible to bonuses from the $500 million pool. The bonus payments keep on increasing with each passing MIPS evaluation period.
The 70 points will earn you a place in the elite class of doctors and practitioners who give maximum attention to their patients. They care for them to the best of their ability, and in return reap the profits. In doing so, they take the US healthcare system one-step closer to glory.
Everybody is a Winner
QPP 2018 has something for everyone. The clinicians reap the rewards in terms of positive payment adjustments, the patients go home feeling well, and the government feels the pride in its policy structure.
MIPS 2019 – A Brief Overview
We have gone one step ahead. Now in the 3rd performance year of MIPS, the percentage of all performance measures has changed as follows.
MIPS penalty level has gone to -7% and the minimum score to avoid a penalty is 30 points.
The scores for each performance category are:
- Quality 45%
- Promoting Interoperability 25%
- Improvement Activities 15%
- Cost 15%
Every eligible clinician who reports for Medicare Part 2 or Critical Access Hospital (CAH) Method II payments can participate in MIPS 2019. Moreover, every clinician can report as a group or as an individual but it applies across all categories.
It means, if a clinician chooses to report individually, he can report solely with this submission method for all categories.
Eligible clinicians have lots of chances to earn incentives and bonuses in this year by performing well for interoperability and maintaining quality.
The resulting situation brings down healthcare expenses and improves efficiency. Everybody gets to be a winner.
We are an approved MIPS registry to report data on your behalf. Dial 1-844-557-3227 (1-844-55-P3CARE) or email at firstname.lastname@example.org to talk to a trained HIT consultant.