2018 Quality Payment Program: What is the Merit-Based Incentive Payment System (MIPS)

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:

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
  • Chiropractors
  • 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.

  • Promoting Interoperability (PI), formerly 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 PI base score, which consists of Security Risk Analysis, e-Prescribing, Providing Patient Access, and Health Information Exchange.

    • The PI base score comprises 50% of the total PI score. If a clinician chooses to pursue a higher percentage, he or she will have the option to report on additional PI performance score measures to increase the total PI score and improve the overall MIPS score.

    • The PI 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.

More information

  • You can visit Practice Fusion's Quality Payment Program resource center here.
  • Access the CMS Fact Sheet for 2018 Quality Payment Program reporting Year 2 here.
  • CMS also provides further resources for 2018 Quality Payment Program here.  

Quality Payment Program

  1. 2018 Quality Payment Program: What is the Merit-Based Incentive Payment System (MIPS)
  2. What is the MIPS Dashboard watch list and how do I use it?
  3. How does the MIPS Dashboard work?
  4. What is the Promoting Interoperability (formerly Advancing Care Information) performance category in MIPS?
  5. 2018 What is the Quality performance category in MIPS?
  6. 2018 What are Improvement Activities in MIPS?
  7. Which Improvement Activities qualify for the Promoting Interoperability performance category bonus in 2018?
  8. What is the Cost performance category of MIPS and how is it scored in 2018?
  9. How is the MIPS Final Score Calculated in 2018?
  10. What is a MIPS eligible clinician in 2018?
  11. MIPS for Small, Rural and Underserved Practices
  12. 2018 PI Transition Measure: Medication Reconciliation
  13. 2018 PI Transition Measure: Electronic Prescribing (eRx)
  14. 2018 PI Transition Measure: Secure Messaging
  15. 2018 PI Transition Measure: Security Risk Analysis
  16. 2018 PI Transition Measure: Health Information Exchange
  17. 2018 PI Transition Measure: Immunization Registry Reporting
  18. 2018 PI Transition Measure: Specialized Registry Reporting
  19. 2018 PI Transition Measure: Syndromic Surveillance Reporting
  20. 2018 PI Transitional Measure: View, Download, or Transmit (VDT)
  21. 2018 PI Transition Measure: Provide Patient Access
  22. 2018 PI Transition Measure: Patient-Specific Education
  23. What is the Practice Fusion QCDR?
  24. 2017 Quality Payment Program: What is the Merit-Based Incentive Payment System (MIPS)
  25. How do I report my 2017 MIPS data to CMS using the Practice Fusion QCDR?
  26. What is the Advancing Care Information (ACI) Performance Category for MIPS and how is it scored?
  27. 2017 ACI Transition Measure: Security Risk Analysis
  28. 2017 ACI Transition Measure: Electronic Prescribing (eRx)
  29. 2017 ACI Transition Measure: Provide Patient Access
  30. 2017 ACI Transition Measure: Health Information Exchange
  31. 2017 ACI Transition Measure: View, Download, or Transmit (VDT)
  32. 2017 ACI Transition Measure: Patient-Specific Education
  33. 2017 ACI Transition Measure: Secure Messaging
  34. 2017 ACI Transition Measure: Medication Reconciliation
  35. 2017 ACI Transition Measure: Immunization Registry Reporting
  36. 2017 ACI Bonus Measure: Syndromic Surveillance Reporting
  37. 2017 ACI Bonus Measure: Specialized Registry Reporting
  38. What is the Improvement Activities Performance Category for MIPS?
  39. What are the Quality performance category reporting requirements for MIPS?
  40. What is the difference between the two Advancing Care Information measure sets available in 2017?
  41. Advanced APM: What is Comprehensive Primary Care Plus (CPC+)?
  42. Which Improvement Activities Qualify for the Advancing Care Information (ACI) Bonus Score in 2017?
  43. How is the MIPS Final Score Calculated?
  44. How do I contact CMS about the Quality Payment Program?
  45. How do I indicate interest in the Practice Fusion QCDR and get my MIPS estimated scores?
  46. Chronic Care Management FAQs
  47. How do I export a JSON file for 2017 MIPS reporting?

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