Implemented by the Centers for Medicare and Medicaid Services, the Merit-based Incentive Program (MIPS) is a part of the Quality Payment Program (QPP). It has been designed to tie payments to quality and cost-efficient care, drive improvement in care processes and health outcomes, increase the use of healthcare information, and reduce the cost of care.
Under MIPS, performance is measured through the data clinicians report in four areas: quality, improvement activities, promoting interoperability, and cost. Final score determines what your payment adjustment will be.
This program has undergone a number of changes since it was first implemented and can be confusing. The following are five things you should know about MIPS.
Are your providers eligible to participate? CMS will not be sending letters to your providers to let them know if they are eligible to participate in 2018 MIPS. A great way to determine eligibility is by setting up an EIDM account. This account will give you access to things such as your Quality Resource and Use Report (QRUR), your MIPs score and your eligibility.
Not every clinician is required to participate in MIPS. Even if you’ve made only small changes to your practice, it’s important to check your participation status. Eligible clinicians can report as individuals, with payments adjusted based on individual performance. Option two is to report as part of a group and receive payment adjustment based on group performance.
3. Penalties/Incentives Increase
The payment adjustment for not participating in MIPS increases to a minus five percent in 2018, which is a one percent increase from 2017. The maximum incentive available to participants is plus five percent, also up from 2017.
4. Performance Threshold
For 2017, a MIPS score of just three was enough to allow providers to avoid the negative Medicare adjustment. The MIPS performance threshold has significantly increased and is now 15 points instead of three. While the performance threshold has increased to 15, the exceptional performer threshold will remain at 70 for 2018. For 2018, submitting one measure to CMS will no longer be enough to avoid a penalty.
Cost scoring is based on Medicare spending per beneficiary and the total per capita cost. The fourth MIPS category, Cost, will be calculated in your 2018 MIPS score. In 2017, CMS looked at only three MIPS components: Quality, Improvement Activities, and Promoting Interoperability (formerly ACI). In 2018, Cost will be added to that list of MIPS components. Cost will represent 10 percent of your total MIPS score. The MIPS quality component will now be worth 50 percent (instead of 60 percent) of the providers’ final score.
The guidelines for MIPS continue to change focused on value-based care and with those changes, planning and preparation become even more important for urgent cares. If you want more information, our experts will be happy to answer your questions. Just email our MIPS team.