MIPS was designed to tie payments to quality and cost efficient care, drive improvement in care processes and health outcomes, increase the use of healthcare information, and reduce the cost of care.

Macra and Mips2021-04-14T21:56:32+00:00

Quality Payment Program

What’s the Quality Payment Program?

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) ended the Sustainable Growth Rate (PDF) (SGR) formula, which would have significantly cut payment rates for participating Medicare clinicians. MACRA requires us to implement an incentive program, the Quality Payment Program. Clinicians have two tracks to choose from in the Quality Payment Program based on their practice size, specialty, location, or patient population:

  • MIPS: Merit Based Incentive Payment System

  • APMS: Advanced Alternative Payment Method

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Merit-based Incentive Payment System

MIPS Score

There are four performance categories that make up your final score. Your final score determines what your payment adjustment will be. These categories are:

  • Quality (45% of final score)

    This performance category replaces PQRS. This category covers the quality of the care you deliver, based on performance measures created by CMS, as well as medical professional and stakeholder groups.

  • Improvement Activities (15% of final score)

    This is a new performance category that includes an inventory of activities that assess how you improve your care processes, enhance patient engagement in care, and increase access to care. The inventory allows you to choose the activities appropriate to your practice from categories such as, enhancing care coordination, patient and clinician shared decision-making, and expansion of practice access.

  • Promoting Interoperability (25% of final score)

    CMS is re-naming the Advancing Care Information performance category to Promoting Interoperability (PI) to focus on patient engagement and the electronic exchange of health information using certified electronic health record technology (CEHRT). This is done by proactively sharing information with other clinicians or the patient in a comprehensive manner

  • Cost Measures (15% of final score)

    This performance category replaces the VBM. The cost of the care you provide will be calculated by CMS based on your Medicare claims. MIPS uses cost measures to gauge the total cost of care during the year or during a hospital stay. Beginning in 2018, this performance category will count towards your MIPS final score.

MIPS Quality Measure Data

Participants must collect measure data for the 12-month performance period (January 1 – December 31, 2019). The amount of data that must be submitted depends on the collection (measure) type.

There are 5 collection types for Quality measures that you can use:

  • Medicare Part B claims measures

  • The CAHPS for MIPS survey

  • Electronic Clinical Quality Measures (eCQMs)

  • MIPS CQMs (formerly “Registry measures”)

  • Qualified Clinical Data Registry (QCDR) Measures

Who is Eligible

If you’re an eligible clinician type, you must participate in MIPS if you

  • Exceed the low-volume threshold as an individual
  • Enrolled in Medicare before January 1, 2019
  • Don’t become a QP or Partial QP
  • Are part of an APM Entity with Partial QP Status that elects to participate in MIPS

MIPS Eligible Clinician Types

Clinical Nurse Specialists, Certified Registered Nurse Anesthetists, Qualified Audiologists, Clinical Psychologists, Registered Dietitians or Nutritional Professionals, Physician Assistants, Physical Therapists, Nurse Practitioners, and Occupational Therapists. Physicians (including doctors of medicine, osteopathy, dental surgery, dental medicine, podiatric medicine, and optometry; osteopathic practitioners.)

Why report MIPS?

Physicians are being rewarded for providing high quality care, improvement and reporting to the CMS. With MIPS, physicians have the potential to earn a positive payment adjustment. If physicians decide not to report they will be penalized and lose compensation.

  • MIPS: Merit Based Incentive Payment System

  • APMS: Advanced Alternative Payment Method

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