What is the Quality Payment Program?
The Quality Payment Program was created under the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) and began on January 1, 2017. The Quality Payment Program has two paths for participation:
- The Merit-based Incentive Payment System (MIPS)
- Advanced Alternative Payment Models (Advanced APMs)
What is MIPS?
The Merit-Based Incentive Payment System (MIPS) is one of the two new payment programs that will be used by CMS to determine Medicare payment adjustments for eligible clinicians under the Quality Payment Program. MIPS combines elements of existing Medicare quality programs -- the Physician Quality Reporting System (PQRS), the Physician Value-based Payment Modifier (VM) Program, and the EHR Incentive Program (Meaningful Use) -- into one MIPS score.
Unlike the previous quality programs, scoring under MIPS is not all-or-nothing, but instead is determined based on an eligible clinician’s participation and performance levels. Once an eligible clinician’s MIPS score is calculated, the clinician may receive a positive payment adjustment or no payment adjustment. MIPS reporting began in 2017 and payment adjustments will begin in 2019.
Not participating in the Quality Payment Program in 2018 could result in a negative 5% payment adjustment in 2020. Payment adjustments will continue to take effect two years after the relevant reporting year.
What has changed in MIPS in 2018 compared to 2017?
- CMS has raised the low-volume exemption threshold to less than or equal to $90,000 Medicare Part B charges OR less than or equal to 200 Medicare patients.
- The weight of the Cost performance category has been raised and now counts towards 10% of the total MIPS score.
How do I know if I am eligible?
To determine whether you need to submit data to CMS for MIPS, you can check CMS's eligibility lookup tool here: Am I Included in MIPS? In general, the following Medicare Part B clinicians are eligible for MIPS participation:
- Doctors of Medicine (MD)
- Doctors of Osteopathy (DO)
- Doctors of Dental Surgery/Dental Medicine (DMD/DDS)
- Doctors of Podiatry
- Doctors of Optometry
- Physician Assistants (PA)
- Nurse Practitioners (NP)
- Clinical Nurse Specialists
- Certified Registered Nurse Anesthetists
However, you may be exempt from participation in MIPS during 2018 if one or more of the following applies to you:
- You are a practitioner who is newly enrolled in Medicare.
- NEW! You are a practitioner who either has 1) less than or equal to $90,000 in Medicare Part B charges, OR 2) less than or equal to 200 Medicare patients.
- You are a practitioner who is significantly participating in an Advanced APM.
What are my reporting requirements for MIPS in 2018?
For the 2018 reporting year, a clinician’s MIPS score will be based on four, previously three, performance categories.
Quality: This performance category replaces PQRS. The quality measures included are related to patient outcomes, appropriate use of medical resources, patient safety, efficiency, patient experience and care coordination.
Eligible clinicians will report up to 6 quality measures, including at least one patient outcome measure, for a full performance year.
The Quality performance category will account for 50% of a clinician’s total MIPS score for the entire 2018 reporting year (Year 2).
Improvement Activities: The measures in this category focus on patient safety, care coordination, beneficiary engagement, population management and health equity. Most participants will complete up to 4 improvement activities for at least 90 days. Groups with fewer than 15 participants, or clinicians in a rural or a health professional shortage area, may complete up to 2 improvement activities for at least 90 days. The Improvement Activities performance category will account for 15% of a clinician’s total MIPS score for the 2018 reporting year (Year 2). Examples of Improvement Activities include, but are not limited to:
Use of a certified EHR to capture patient reported outcomes.
Engagement of patients, family and caregivers in developing a plan of care.
Chronic care and preventative care management for empaneled patients.
Advancing Care Information (ACI): This performance category replaces the Medicare EHR Incentive Program (Meaningful Use). This performance category includes measures that exhibit how well clinicians use their certified EHR technology, primarily where it involves interoperability and health information exchange.
A clinician can choose to report on the minimum 4 required measures to achieve the ACI base score, which consists of Security Risk Analysis, e-Prescribing, Providing Patient Access, and Health Information Exchange.
The ACI base score comprises 50% of the total ACI score. If a clinician chooses to pursue a higher percentage, he or she will have the option to report on additional ACI performance score measures to increase the total ACI score and improve the overall MIPS score.
The ACI performance category will account for 25% of a clinician’s total MIPS score for the 2018 reporting year (Year 2).
Cost: Also known as resource use, the Cost performance category replaces the Value-Based Modifier program and will consist of specialty-based measures that encourage efficient resource use.
Cost measures will be determined based on Medicare claims, with no additional reporting requirements for participating clinicians.
The Cost performance category will account for 10% of a clinician’s total MIPS score for the entire 2018 reporting year (Year 2).
Practice Fusion makes reporting for MIPS easy
Practice Fusion’s MIPS Dashboard is an easy-to-manage tool that allows you to track your progress for MIPS. You can use the MIPS Dashboard and its intuitive watch list functionality to monitor your performance on the MIPS measures and activities you may want to report, with no limit to the number of items you can track throughout the year. The 2018 MIPS Dashboard is available as part of a Practice Fusion EHR subscription plan.