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MACRA repealed the Sustainable Growth Rate formula and created the Quality Payment Program.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
• < = 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 measure 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 measure 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: l 2 high-weighted activities l 4 medium-weighted activities l 1 high-weighted activity and 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: l 1 high-weighted activity l 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.