Practice Benefits of MIPS Program Participation

MIPS is the Medicare value-based care payment program. Beginning in 2018, CMS will begin publishing MIPS scores from 2017 for over 500,000 clinicians to provide patients with more information about their medical care providers. Each calendar/performance year eligible providers will receive a score based on a 100 point scale. Practices must meet a certain minimum threshold, with incentives provided for going beyond that minimum. A MIPS performance score is measured through the data clinicians report in four areas, plus additional bonus point opportunities:

1. Quality – 45% weight, or 45 MIPS points maximum: This category covers the quality of care delivered by a practice, based on certain performance measures created by CMS, as well as medical professional and stakeholder groups. Each provider will pick the six measures of performance that best fit their practice.
2. Promoting Interoperability – 25% weight, or 25 MIPS points maximum: This measurement focuses on patient engagement and the electronic exchange of health information using certified electronic health record technology. Practices are encouraged to proactively share information such as visit summaries, test results and treatment plans with other clinicians, facilities or the patient in a comprehensive manner.
3. Improvement Activities – 15% weight, or 15 MIPS points maximum: This area is focused on motivating providers to constantly assess how they can improve care processes, enhance patient engagement, and improve population health. Practices can choose activities from such categories as enhancing care coordination, expansion of practice access, and increasing shared decision-making.
4. Cost – 15% weight, or 15 MIPS points maximum: Beginning in 2018, CMS will review Medicare claims submitted, in order to calculate the total cost of care provided during the year.

Using these scores, adjustments are applied to every Medicare Part B item and service billed by the clinician two years after the rating year. For example, 2019 will be the payment adjustment year based on performance ratings from 2017. In 2019, the maximum MIPS incentive is 4%, with a maximum exceptional performance bonus of 10% and a maximum MPS penalty of 4%. Incentives and penalties will increase through payment year 2022 to a maximum of 9% each. Penalties applied to poor performers will help create a pool to pay incentives earned by the higher-rated performers.

Practices must earn a minimum number of points to avoid receiving an MIPS penalty. This can be accomplished through a combination of meeting base scores and submitting quality measures that meet data completeness thresholds or specifically-weighted improvement activities. There are more than 270 quality measures that are final for reporting for the 2018 performance period in the Quality Payment Program. These cover process measures, outcome measures and high priority measures.

1. The data completeness threshold for each quality measure is 70% of all eligible instances. Best practice is to be over 70%. To determine included instances the practice will:
   Determine a reporting period of a full year.
2. Count all patients seen during the reporting period, not just the Medicare population.
3. Break down the patient population by factors such as age group and diagnosis code (depends on the measure ifbroken down).
4. Review the specific instructions for the quality being measured to determine the Eligible Instances.
5. Divide the Eligible Instances by two to determine the minimum number of included instances.
6. Report from 60-100 percent of the Eligible Instances

CMS plans to gradually increase competition for practices to provide higher levels of care by increasing financial and reputation impacts through 2022.