Merit-based Incentive Payment System (MIPS)

  • Beginning in 2017 MIPS will replace the PQRS, Value Based Modifier and Meaningful Use programs.
  • MIPS is comprised of four performance categories: Cost, Quality, Practice Improvement and Advancing Care.
  • Bonus payments will go to the highest performers.
  • Penalties will continue to grow.

2019                    2020                    2021                    2022 and after

4%                       5%                       7%                       9%

  • At a federal level MIPS must be budget neutral, meaning all of the incentives must be covered by penalties.  Thus if your organization does not successfully implement a MIPS strategy the penalties you incur may be distributed as bonuses to competitors.
  • For organizations with significant Medicare populations this must be one of your highest priorities in 2017 and planning should start now.

 

American Health IT can help you stay ahead of the MIPS curve in the following ways:

  1. As a qualified registry, handling analysis and submission of the best six quality measures used to address the Quality performance category.
  2. Through very timely (weekly or monthly) analysis of Medicare claims costs with comparison against national benchmarks in order to address the Cost performance category.
  3. By helping to design clinical practice improvement programs such as care coordination, beneficiary engagement and patient centered medical home to address the Practice Improvement performance category.
  4. As a Specialized Registry, reporting public health and clinical data registry data to address the Advancing Care performance category.

 

Background

  • MACRA – Medicare Access and CHIP Reauthorization Act of 2015
  • QPP – Quality Payment Program
  • MIPS – Merit-based Incentive Payment System

MACRA is the legislation passed by Congress that repeals the Sustainable Growth Rate formula and replaces existing health reporting and payment programs with the QPP.

The QPP is a framework with two distinct paths for demonstrating value and quality of care.  One path is participation in Advanced Alternative Payment Models (APMs) which are not feasible for most clinicians. The other, more common path is MIPS, which combines elements of PQRS, VBM, and Medicare EHR Incentive Program into one comprehensive reporting program that replaces all three.

The relationship between MACRA, QPP, and MIPS is as follows: MACRA is the legislation that establishes and outlines the QPP. The QPP is a new program for health care reporting and reimbursement that consists of two paths. MIPS is one of the paths for successful participation in QPP.”

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