MIPS

MIPS - Merit Based Incentive Payment System

MACRA repealed the Sustainable Growth Rate formula and created the Quality Payment Program. The Quality Payment Program changes the way Medicare pays clinicians and streamlines multiple quality programs. There are two options to choose from based on practice size, specialty, location or patient population. These are MIPS and APM (Advanced Alternative Payment Models). Most clinicians will be subject to MIPS unless they are in their 1st year of Part B participation, become QPs through participation in Advanced APMs, or have low volume of patients.

Who Does MIPS Affect? Medicare Eligible Clinicians

• Physicians
• Physician Assistants
• Nurse Practioners
• Clinical Nurse Specialists
• Certified Nurse Anesthetists
• Group that include such clinicians

CMS has provided a tool to see if you qualify for MIPS. Go to: https://www.cms.gov/Medicare/Quality-Payment-Program/Lookup-Tools/Lookup-tools.html

EXCLUSIONS

• < 30k Part B
• < = 100 Medicare Patients

MIPS has 4 Performance Categories

• Quality (PQRS) – formerly Physician Quality Reporting System (30%)
• Cost (VM) – formerly Value-Based Modifiers (30%)
• ACI(MU) – formerly MU (25%)
• Process Improvements (15%)

MIPS Reporting Periods - 2017

	PATH 1	PATH 2	PATH 3
Requirements	Report on 1+ quality measures	IA: 90 days	IA: 90 days
	Report on 1+ IA measure	ACI: 90+ days, less than 1 year	ACI Full year
	Report on All Base ACI measures	Quality: 90+ days, less than 1 year	Quality: Full year
Outcomes	No penalty	No penalty	No penalty
	No Incentive	Proportion of potential incentive	Full potential incentive

*** The more measures you report, the higher your score.

MIPS Reporting Periods - 2018

	PATH 1	PATH 2
Requirements	IA: 90 days	IA: 90 days
	ACI: 90+ days, less than 1 year	ACI: Full year
	Quality: Full year	Quality: Full year
Outcomes	Proportion of potential incentive/penalty	Full potential

*** The more measures you report, the higher your score.

MIPS Scoring

MIPS Score will be determined by four Composite Performance Scores:

• Quality – formerly PQRS measure (six or 15)
• Cost – Formerly Value Based Modifiers
• User of Health IT – formerly Meaningful User measure, now called ACI
• Better Process – Improvement Activities (IA) new program

For additional information on scoring visit: https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/MIPS-Scoring-101-Guide.pdf

Quality Category

 Choose 6 measure to report (was 9 with PQRS)
 Groups using web interface report 15 measures
 Each measure is worth  0-10 points (proportionally)
 Translates into 60% of MIPS score (year 1)

Cost Category

 Claims based calculation, no reporting necessary
 10 episode specific measures
 Each measure worth up to 10 points (based on cost efficiency, 20 patient sample min. for ea measure)
 Score is based on average performance across all calculated measures
 No weight in 2017, but results still reported to participants

IA Category - Focused on care coordination, beneficiary engagement, and patient safety

 Can earn up to 40 points
 Groups of >15 will receive 10 points for Medium weighted activities, 20 points for High weighted activities. Pick any of these: 
                                                                                                                  2 high-weighted activities 
                                                                                                                  4 medium-weighted activities 
                                                                                                                  1 high-weighted activity
                                                                                                                  2 medium-weighted activities
 Groups of <15 will receive 20 points for Medium weighted activities, 40 points for High weighted activities. Pick either of these: 
                                                                                                                  1 high-weighted activity 
                                                                                                                  2 medium-weighted activities

For additional information on IA – Improvement Activities visit: https://qpp.cms.gov/mips/improvement-activities

ACI – Advance Care Information – Base Score, Performance Score, and Bonus Score make up the ACI performance score.

Base Score 50% of ACI - All or nothing

Option 1	Threshold	Option 2	Threshold
Security Risks	Yes	Security Risk Analysis	Yes
E-prescribing	>=1 pt/event	E-presribing	>=1 pt/event
Provide patient access	>=1 pt/event	Provide patient access	>=1 pt/event
Send summary of care	>=1 pt/event	Send summary of care	>=1 pt/event
Request/accept summary of care	>=1 pt/event

***Exemptions: ePrescribing < 100, HIE < 100 transfer of care"""

Performance Score - There are two options for reporting performance score measure, based on 2014 CEHRT Edition or 2015 CEHRT Edition

2014 CEHRT = Report up to 9 ACI Measures	2015 CEHRT - Report up to 7 ACI Measures
Provide Patient Access	Provide Patient Access
Patient-specific education	Health information exchange
View, download, and transmit VDT	View, download, transmit
Secure messaging	Patient-specific education
Patient generated health data	Secure messaging
Send summary of care	Medication reconciliation
Request/accept summary of care	Immunization registry
Clinical information reconciliation
Immunization registry reporting

See Advancing Care Information Fact Sheet on: https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/Advancing-Care-Information-Performance-Category-Fact-Sheet.pdf

Bonus Score - up to 5% bonus score

Option 1	Option 2
Syndromic Surveillance Reporting	Syndromic Surveillance Reporting
Electronic case reporting	Specialized registry reporting
Public health registry reporting
Clinical data registry

*** 10% bonus can be earned by using CEHRT to perform certain improvement activities

Scoring Summary

See Advancing Care Information Fact Sheet on: https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/Advancing-Care-Information-Performance-Category-Fact-Sheet.pdfhttps://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/MIPS-Measures-for-Primary-Care-Clinicians.pdf

Category	Number of Measure	Value of ea Measure	Potential Maximum Score	Max Score	MIPS Score %
Quality	8 - 9	10 (measure scored proportionally)	80 - 90	80 - 90	50%
CPIA	90	10 or 20	Hundreds	60	15
Cost	40	10 (measure scored proportionally)	Score based on % achieved for ea measure	10	10
ACI - BaseCost	6	All or nothing	80	100	25
ACI - Performance	8	10 (measure scored proportionally)	80
ACI - PHR	3	>0 = 1	1

See Advancing Care Information Fact Sheet on: https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/Advancing-Care-Information-Performance-Category-Fact-Sheet.pdf

https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/MIPS-Measures-for-Primary-Care-Clinicians.pdf