Insights

MIPS: The basics explained

If you haven’t thought about MACRA yet, the time to start is now. The new Quality Payment Program came into effect January 1, 2017. Let’s start out with the basics...

If you see more than 100 Medicare patients or bill more than $30,000 to Medicare a year, you are subject to participate. For 2017, you must also be a physician, physician assistant, nurse practitioner, clinical nurse specialist, or a certified registered nurse anesthetist. In 2019, this may open up to physical and occupational therapists, speech language pathologists, audiologists, nurse midwifes, clinical social works, clinical physiologists, dietitians and nutritional professionals (more to come on this).

Once you have determined your eligibility, it is time to pick your path and pick your pace. Are you participating in an Advanced Alternative Payment Model (APMs)? If not you will need to participate in the Merit-Based Incentive Payment System (MIPS). The majority of providers will fall into the MIPS pathway in 2017. CMS has made 2017 a transition year and this allows you to pick your pace of participation (see infographic).

MIPS is comprised of four categories: Quality, Advancing Care Information, Clinical Improvement Activities and Cost. Each category is weighted differently and these weights will change from year to year. The point values you earn in each category will be multiplied by their weight and these scores will be added to determine your composite score (__/100).

Quality replaces the current PQRS incentive program. Under MIPS, to fully participate you would need to report on 6 quality measures. For 2017, Quality is worth 60% of your final score. Each quality measure you report on will be scored on a scale between 3 -10. The maximum points you can receive in this category is 60.

Advancing Care Information (ACI) replaces the EHR Meaningful Use. It is no longer an all or nothing category like Meaningful Use previously was. ACI is worth 25% of your final score. Your score is determined by your base score + performance score. The base score components are required to report on but you have more flexibility choosing which performance scores to report. A composite score of over 100 will give you full credit.

Clinical Improvement Activities are new to MIPS and they may be things you are already doing or will need to implement into your practice for 90 days. Improvement Activities are a little trickier to score; the threshold is based off the size of your practice. If you are a small or rural practice (15 providers or less) you will only need to complete two improvement activities. Medium weighted activities are worth 10 points and high weighted activities are worth 20. For larger practices you are required to reach 40 points (or complete four medium weight Improvement Activities) in order to receive full credit.

Finally, Cost replaces the Value-Based Modifier. Cost will not be calculated until 2018, but this will be a category you will want to keep an eye on. In 2018, Cost will account for 10% of your final score and this jumps to 30% by 2021.

Navigating the new quality payment can seem overwhelming at first. It is important to put an action plan in place as soon as you determine you are eligible/ required to participate. Remember 2017 is a transition year, so if you do not think your practice is ready to jump right in you should consider at least reporting minimum data to avoid the penalty. NCDS is ready for MIPS and we are here to help your practice succeed in the program from simply answering questions to reporting on your behalf. Stayed tuned for the next installment in our MIPS series- How to choose the right quality measures for your practice.