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MIPS 2019, MIPS 2019 reporting, MIPS & MACRA, MIPS in healthcare, Quality payment program 2019

5 Key Takeaways from the Quality Payment Program by Year’s End

The Merit-based Incentive Payment System (MIPS) comes under the direct obligation of the Medicare Access and CHIP Reauthorization Act (MACRA), the law that regulates the incentive program across the US. It is the practical start of the value-based care model.

Eligible clinicians (ECs) have a responsibility to report MIPS 2019; they include physicians, osteopathic practitioners, chiropractors, physician assistants, nurse practitioners, and registered dietitians or nutritionists among others. To summarize, providers are to fulfill the low-volume threshold to qualify for MIPS 2019 reporting. Moving on to MIPS 2020, your next goal has its own set of requirements.

MIPS in healthcare gauges a clinician’s performance in terms of care delivery and reduced expenses. In this article, we come to an understanding of five key elements in relation to this program. In fact, the following data correlates with the preliminary data findings released by CMS on July 11, 2019.

  1. Two Branches for Positive Payment Adjustments

The Quality Payment Program (QPP) 2019 branches out into MIPS and Advanced Alternative Payment Models (APMs). Whichever path you choose, it results in incentives for eligible clinicians, clinician groups, and virtual groups.

Furthermore, MIPS & MACRA go side by side; it is the popular track with stats and reports going in its favor. MIPS incentives for 2019 are less as compared to incentives in MIPS 2020. On the whole, the program is evolving, but once it does, it will be the birth of an improved healthcare system.

It divides into four performance categories such as Quality, Promoting Interoperability (PI), Improvement Activities (IA), and Cost. Each category has certain measures that have to be reported through a MIPS Qualified Registry, CMS Web Interface, EHR, or Qualified Clinical Data Registry (QCDR). Not to forget, there is another catch to it in the form of collection types, which are the actual measures according to their submission systems.

  1. Participation Level Increases Each Year

Since the start of the program in 2017, the participation level has gradually increased. It showed an increase from 95% in 2017 to 98% in 2018. Moreover, MIPS 2019 is only going to give us more eligible clinicians participating in it. The whole program suggests progression with higher participation levels across the country.

  1. Small Practices Clinician Participation Status

According to the Centers for Medicare & Medicaid Services (CMS), 90 percent of clinicians from small practices engaged in MIPS 2018 which was 81 percent in 2017. So, that’s a 9% increase.

The primary flexibilities introduced in the Physician Fee Schedule (PFS) rule for the 2018 performance year included an increase in Medicare patient count and Medicare Part B allowed charges.

What did it mean?

It meant fewer clinicians from small practices were eligible to report MIPS in 2018. On the contrary, they decided to report it anyway. It goes to show that the system adjusted itself with practitioners’ convenience.

It was mentioned in a blog post by Seema Verma, Administrator CMS on July 11, 2019.

  1. Advanced APMs Are Not Far Behind

Alternative Payment Model’s (APM) participation level isn’t far behind that of MIPS. CMS reports twice an increase of participants in 2018 as compared to 2017. There were 99,076 total participants in 2017, while the number doubled to 183,306 in 2018. We attribute this jump to new participation opportunities in 2018, especially through ACOs in the Medicare Shared Savings Program.

Even if we are to condemn MIPS in general, I can’t see any downside to opportunities and hope that clinicians continue to grab MIPS incentives year after year.

  1. Spectacular Results So Far

The program collects incentives for the participating clinicians year after year, but the payout occurs one year after the performance year. For example, the payout for MIPS 2017 happened in 2019 in which 93 percent of the participants received positive payment adjustments.

Similarly, MIPS 2018 participants will receive a payout in 2020 which is almost here. CMS reports that 97 percent of the clinicians will be the owner of positive payment adjustments in 2020 based on their performances in 2018.

P3 Healthcare Solutions, Ontario, CA keeps an eye on what goes around as the MIPS performance period 2019 enters the final stages.

2019 mips quality measure specifications, mips by cms, mips 2019, cms quality measures, qualified registry for mips, QPP 2019

MIPS Quality Measure Specifications 2019 in a Nutshell

By the term ‘Measure Specification’, it means the detailed description of a measure. Therefore, 2019 MIPS Quality measure specifications are the detailed guidelines of quality measures intended to be used by individuals MIPS eligible clinicians reporting CQMs via Qualified Clinical Data Registry (QCDR) or Qualified Registry and by groups reporting via Qualified Registry for the QPP 2019.

To make things simpler, each measure specification has a measured flow and related algorithm as additional help for data completeness and performance. However, a measure specification should be considered final descriptive information on measures because measure flows may or may not be attested by the Measure Steward.

A Brief Recap

MIPS by CMS is an evaluation system by which eligible clinicians can submit their performance with the government to stay compliant and eventually become well-established healthcare professionals. It is a metric to judge the quality of care and their performance via the submission of certain measures or measure sets.

MIPS 2018 was the successful application of performance analysis for many clinicians which brings us to MIPS 2019 and what it has in the box for them. Measures are not difficult to finalize, but an understanding of measure’s specifications helps each participant what exactly they are about to submit. Measure specifications also highlight their key aspects, the number of times they are to be reported, respective codes, and more.

ECs must report at least 6 MIPS quality measures in 2019 including at least 1 outcome measure or a high priority measure, or to report on a complete measure specialty or sub-specialty set.

What is New in 2019?

The government has come up with an improved criterion for 2019 to measure the performance of clinicians giving them freedom in the following ways:

  • CMS adds opioid-related quality measures to the set of high priority measures.
  • In 2019, you get more options in terms of submitting the same measure through different collection types (that include QCDR, MIPS CQMs, CMS Web Interface, and Medicare Part B Claims Measures) to optimize your score for that measure.
  • You can choose measures from different collection types available to you to find the most meaningful measures for your practice.

Understanding 2019 MIPS Quality Measure Specifications

Clinical Quality measures specifications encompass the guidelines to follow during the submission of CMS MIPS quality measures. Each measure is distinguished by a unique identifier. These are the numbers that represent continuity from measures in the 2018 QPP.

Furthermore, Measure Stewards have decided on these measures by applying some changes to the list of MIPS quality measures in the previous performance year.

  1. Frequency of a Measure

Frequency labels are part of each measure’s execution plan as well as part of the measured flow. The analytical submitting frequency suggests the time frame for which a measure needs to be submitted. Each eligible clinician participating in MIPS 2019 has to submit measures according to their given frequency. The definitions adhered to under the frequency label concerning 2019 MIPS Quality measure specifications are mentioned below:

  • Patient-Intermediate measures follow submissions minimum once per patient during the performance year. The most current quality codes should be utilized in case the measure needs submission more than once.
  • Patient-Process measures submissions happen once per patient at the minimum during the performance year. The most rewarding quality-data code is used if the measure undergoes submissions more than once.
  • Patient-Periodic measures undergo submissions once per patient at the minimum during the performance year. If it is submitted more than once, use the most rewarding quality-data code. If two or more quality codes are submitted, performance shall be evaluated through the most rewarding quality-data code.
  • Episode-based measures are submitted once per occurrence of an illness or condition during the performance year.
  • Procedure-based measures undergo submissions each time a procedure occurs during the performance year.
  • Visit-based measures go through submissions every time a patient visits the MIPS eligible clinician in their clinic or hospital during the performance period.
  1. Performance Period

The performance period for a measure may refer to the time duration from January 1 to December 31. There are many sections to a measure specification like Instruction, Description or Numerator Statement that may hold the details on the performance period.

  1. Denominator and Numerator

Quality measures consist of a numerator and denominator that are used to evaluate data completeness which forms the final score of the MIPS eligible clinician.

As a Qualified Registry for MIPS, P3 Healthcare Solutions, Ontario, CA works on behalf of clinicians to help them achieve scores above 75. Such high scores in 2019 can pave the way towards a future in which there is fame, respect, and ultimately high income. For the latest on Merit-based Incentive Payment System visit our company page on LinkedIn – https://www.linkedin.com/company/p3-healthcare-solutions/

Do you think the QPP program correlates with the demands of the healthcare sector?