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The Merit Based Incentive Payment System 101 with Sarah

MIPS-101

What is MIPS?

The Merit-based Incentive Payment System better known as MIPS. It is the new way that eligible clinicians will be measured and CMS will determine if they are providing quality patient care with improved patient outcomes in an economically efficient way.  Simply put: is the physician being a good provider and not costing Medicare a bunch of money? MIPS is based on the principle that if you demonstrate higher quality and/or lower costs than your peers, you have the chance to make more money.

What happened to PQRS, MU and the VBM?

In years prior to 2017, eligible clinicians (previously termed eligible providers) were measured using three different programs: the Physician Quality Reporting System (PQRS), the EHR Incentive Program (aka Meaningful Use), and the Value Based Modifier (wrapped up in PQRS and billing claims). Beginning January 1, 2017, all of these programs have been rebranded and became categories in MIPS:

  • PQRS is now Quality,
  • Meaningful Use is now Advancing Care Information (ACI), and
  • Value Based Modifier is now Cost.

How a provider performs in each of the categories, plus a new one called Improvement Activities, gives an overall MIPS composite score. All of those scores now add up to the MIPS Composite score.

Each of these categories count for a different percent of that composite score in 2017:

  • Quality is worth 60%
  • ACI is worth 25%
  • Improvement Activities is worth 15%
  • Cost is unique. For 2017 it is weighted to 0%. We will see Cost become a player in 2018.

Who should be reporting MIPS?

A provider will be considered an eligible clinician (EC) if they bill more than $30,000 in Medicare Part B charges AND see more than 100 Medicare patients for the year. If they do not meet this threshold, they can be excluded from reporting MIPS in 2017.

There is a new list of the types of providers that could report MIPS:

  • Physician
  • Physician Assistant (PA)
  • Nurse Practitioner (NP)
  • Clinical Nurse Specialist (CNS)
  • Certified Registered Nurse Anesthetist (CRNA)

Physicians have had to report in all programs previously whereas the rest may not have had to report. The biggest difference here is that now PAs and NPs, and the rest on that list, can be eligible to perform the measures for ACI. There are nuances here that providers should look into for their own specific practice. And of course, a phone call to CMS is always a good idea when questions arise!

Are Incentives Really Coming Back?

Yes! For 2017, an EC can earn an upward, downward, or neutral payment adjustment for 2019. The size of the payment adjustments is dependent on a few things: the composite score an EC reports, how well all of the ECs in the country perform, and how many of them participate. For the performance year of 2017, an EC can earn up to a 4% upward or downward payment adjustment on their Medicare reimbursement for 2019. Payment adjustments are assigned two years after a performance year.

MIPS is budget neutral meaning that the downward payment adjustments given to poor performers will pay the upward payment adjustments of the ECs who perform well. So if there is a large amount of this penalty money, the upward payment adjustments could be even larger, up to 3x that 4%!

How does Modernizing Medicine help our providers?

Modernizing Medicine is unique in a lot of ways and one of our differentiating factors is that our goal as a company is to reduce the burdensome task that meeting these measures can be. How do we do this you may be wondering? Keep reading to find out.

  • We have a comprehensive dashboard for providers to see their MIPS score in real time. This dashboard can be seen by all users of EMA which is HUGE because MIPS is a team sport! From check in to check out, almost every single member of the care team has a role to play in meeting measures. This dashboard allows them to double check and make sure they have covered their bases. We are one of the first EHR vendors in the country to provide this report to our users. EMA-zing!
  • Speaking of being one of the first, we have Analytics (currently only generally available in dermatology). Currently, CMS determines how an EC performs based on data that is at least a year, sometimes 2 years old. With Analytics, our users can see how they measure up to all of the other ModMed providers in the country in real time, giving them an advantage to make sure they are staying ahead of the curve to maximize their chance at a piece of the upward payment adjustment pie!
  • Modernizing Medicine is a registry for our providers to report their Quality measures. Not only does our Quality module collect their data, they can use us to seamlessly report their Quality measures to CMS! This is very special not only because of how easy it is to use but it actually gets the providers bonus points for Quality!
  • Speaking of registries, Modernizing Medicine has our own specialized registries for our providers to opt in to and utilize the comparative reports. We offer at least 2 condition registries per specialty, with plans to add more in the future. This means our users can focus on caring for patients, not reporting their conditions. This also gets bonus points for ACI! Examples of some of the registries for dermatology include:
    • Modernizing Medicine Vitiligo Registry
    • Modernizing Medicine Pruritus Registry
    • Modernizing Medicine Melanoma Registry
    • Modernizing Medicine Keloid Registry
  • Many of the Quality measures are built right into the software. The MIPS Quality module will determine if a patient is eligible for a measure, and often will even determine if the performance was met for a patient, all based simply on documentation during the visit. Built right into your workflow? Yes, please!
  • Modernizing Medicine made headlines by announcing the unprecedented modmed Pledge™. We offer two advising program options to help our providers either avoid a downward payment adjustment or go for the upward payment adjustment. These both come with a money back guarantee.

With Modernizing Medicine’s MIPS intelligence platform combined with our modmed Pledge and industry experts, we have what you need to achieve MIPS success.

sarah-lowther-modernizing-medicine

The Author

Sarah Lowther
Compliance Advisor

 

Sarah Lowther is a Compliance Advisor for Modernizing Medicine and is certified in MIPS, Meaningful Use and PQRS. She provides dedicated advice and guidance to clients on the ever-changing landscape of CMS compliance programs. Sarah has worked in healthcare since 2002, first as a surgical tech in the operating room and then in dermatology clinics. That’s right, she was an EMA user first! Sarah was born and raised in Louisiana, just outside of New Orleans. She has two spirited daughters and a husband with whom she shares a love of college football with. Geaux Tigers! Sarah loves to cook, especially Cajun and Creole food, dance, and she’s actually certified to teach ballet, tap and jazz.

Want to learn more about the modmed Pledge? Click here.