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MIPS Basics
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The MACRA Martini: Shaking up Your Practice
Quality Cost Improvement Activities Advancing Care Information Value-Based Modifier PQRS Meaningful Use Performance Year begins in 2017
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MIPS: Who’s In Years 1 – 2 (2017-2018) Potential additions (2019+)
Physicians Physician Assistants Nurse Practitioners Clinical Nurse Specialists Certified Registered Nurse Anesthetists Potential additions (2019+) Physical or Occupational Therapists Speech Language Pathologists Audiologists Nurse Midwives Clinical Social Workers Clinical Pathologists Clinical Psychologists Dietitians/Nutritional Professionals
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MIPS: Who’s Out Providers below the Medicare low-volume threshold
$30,000 OR 100 or fewer beneficiaries annually First year Medicare providers Providers in an Advanced Alternative Payment Model
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Add each weighted category to earn MIPS Composite Performance Score
MIPS: Four Components Quality: 60% 60-70 Points Advancing Care Information: 25% 100+ Points Improvement Activities: 15% 40 Points Cost: 0% Add each weighted category to earn MIPS Composite Performance Score Quality Advancing Care Information Improvement Activities Cost MIPS Score
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MIPS: Quality Measures Examples
60% 60-70 Points List your 6 measures here First Second Third Fourth Fifth Sixth Medicare Shared Savings Track 1: No additional reporting required. Measures are selected for you
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MIPS: Improvement Activities Reporting
15% 40 Points Our IA Activities 1. 2. 3. 4. Categories Expanded Care Access Care Coordination Population Management Beneficiary Engagement Patient Safety and Practice Assessment Achieving Health Equity Emergency Preparedness and Response Integrated Behavior and Mental Health
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MIPS: Advancing Care Information Reporting
25% 100+ Points Security Risk Analysis E-Prescribing Provide Patient Access Send Summary of Care Request/Accept Summary of Care 5 required base measures
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MIPS: Cost Cost: 0% 0% in 2017 10% in 2018 30% in 2019 Cost category rapidly ramps up. Does this influence physician compensation in your group?
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MIPS Payments: Budget Neutral = Winners and Losers
FF: Alternative google - better FF: This does not show it starting in 2017 which is what you say earlier. 2019 payments can go up or down 4% - 9% 2022 Effects payments new model
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MIPS vs. APMs. vs. Advanced Alternative Payment Models
Quality Payment Program MIPS vs. APMs. vs. Advanced Alternative Payment Models Not in APM In APM In Advanced APM MIPS adjustments MIPS adjustments + APM-specific rewards APM-specific rewards + 5% lump sum bonus If you are a Qualifying APM Participant (QP) =
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What Needs to Happen Right Now
Provider engagement and “buy in” Certified EHR Requirements vary based on 2014 vs certification Quality Pick measures Benchmarks vary by submission method Medicare Shared Savings Program? Improvement Activities Patient Centered Medical Home? Cost/Resource Use
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