The Merit-Based Incentive Payment System (MIPS) is one of two payment tracks under the MACRA program. The purpose of the program is to deliver high-quality care for all—including both clinicians and patients—improve beneficiary options, enhance the experience for clinicians, and maximize participation. MIPS consolidates and replaces several previous programs. In this new system, there are four weighted categories: Quality, Cost, Promoting Interoperability (PI), and Improvement Activities. Performance is measured in each of these four categories, according to clinician-reported data and the final score determines part B payment adjustment for future years.
Quality of care is determined by six measures of performance—chosen by the clinician and reported to CMS—that best represents the practice and services. One such selected categories must be an outcome measure. The quality category measures patient experiences and outcomes, coordination of care, efficiency, patient safety, and use of medical resources among others. For 2018, Quality accounts for 50% of the overall MIPS measurement score which is the most heavily weighted of the four.
The cost category replaces the formerly used Value-based Modifier Program (VBM) and currently only carries only 10% of the program’s weight. No data submission is required for clinicians for measurement of cost. The Center for Medicare and Medicaid Services (CMS) calculate the overall cost of care using the clinician’s claim data. This category is essentially the average score of all cost measures. CMS is actively working to develop an improved cost measure for future use.
Promoting Interoperability (PI)
PI—previously named Advancing Care Information—is similar to but replaces the Medicare EHR Incentive Program. The purpose of this measure is to both promote and assess patient engagement and the use of Electronic Health Records (EHR) between medical providers. EHR technology improves information exchange, coordination of care, and patient outcomes. The score is determined by combining two measures – the base score and the performance score, each accounting for 50% of the total PI score. Failure to report on any measures will result in a score of 0, which is a significant deduction as PI accounts for 25% of the overall MIPS measurement score.
Improvement Activities is relatively new to the system. This category comprises 15% of the score. The goal of this measure is to encourage improvements in the clinical practice that benefit clinicians and strengthens long-term care for patients. Medical providers simply report on improvement activities related to things such as shared decision making, care accessibility, and patient safety. During the reporting period, these activities must be carried out for at least 90 consecutive days.
Now that you understand what MIPS is and how the score is determined to let’s discuss the reporting system. MIPS has two options—individual and group reporting. If you are reporting alone, no pre-registration is required, and all of your payments scores will be based on your performance alone in the four categories. If you are group reporting, however, the scores will be based on the group’s performance as a whole. Registration for this is also only required if you are reporting your scores using the web interface under CMS, or if you use the Consumer Assessment of Healthcare Providers and Systems (CAHPS).