AANEM News Express

AANEM News Express

Summary of Merit-based Incentive Payment System (MIPS)

Summary of Merit-based Incentive Payment System (MIPS)

The Medicare Access and CHIP Reauthorization Act (MACRA) is a bipartisan legislation that was passed into law in April 2015. This legislation repeals the flawed Sustainable Growth Rate (SGR) formula and will change the way that Medicare pays clinicians, rewarding value over volume.  Under MACRA, a new framework of payment called the “Quality Payment Program (QPP)” has been proposed. Under the QPP, physicians will be required to utilize one of two paths for reimbursement: Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). It is expected that the majority of physicians will be subject to the MIPS path, at least in the first few years.

MIPS will combine several federal quality programs including the Physician Quality Reporting System (PQRS), Value-based Modifier (VM), and Medicare Electronic Health Record (EHR) incentive program (i.e., Meaningful Use) into a single quality payment system with escalating incentives and penalties.
MIPS is a single program in which eligible clinicians will be measured on four different areas:
  • Quality (replaces the Physician Quality Reporting System [PQRS]): Clinicians will report six measures (down from the nine measures currently required under PQRS). Out of the six measures chosen, one measure needs to be a cross-cutting measure and one needs to be an outcome measure. In the absence of a relevant outcome measure, clinicians may choose another high priority measure. This category gives clinicians reporting options to choose from to accommodate for differences in specialty and practice.
  • Resource Use (replaces the cost component of the Value-based Modifier Program): This category will use more than 40 episode-specific measures to account for differences among specialties. Score will be based on Medicare claims, meaning that there will be no reporting requirements for clinicians.
  • Clinical Practice Improvement Activities (new): Clinicians will be rewarded for clinical practice improvement activities. Activities will be focused on activities such as care coordination, beneficiary engagement, and patient safety.
  • Advancing Care Information (replaces “Meaningful Use” of EHRs): Clinicians will choose to report customizable measures that reflect how they use electronic health record (EHR) technology in their practice. There will be a particular emphasis on interoperability and information exchange. Unlike the current Meaningful Use program, this category will not require all-or-nothing EHR measurement.
Each of these different areas will account for a specific percentage of the total score of 100%:
  • Quality à50% of the total score in year 1
  • Resource Useà10% of the total score in year 1
  • Clinical Practice Improvement Activities (CPIA)à15% of total score in year 1
  • Advancing Care Information (ACI)à25% of total score in year 1
The total percentage received out of 100% will be the clinician’s Composite Performance Score and will be used to compute a positive, negative, or neutral adjustment to Medicare Part B payments. The law requires that MIPS be budget neutral. The law also provides for additional bonus payments for exceptional performance.

MIPS is scheduled to begin January 1, 2017, with payment adjustments (positive, neutral, or negative) to begin in 2019. For more information on MACRA and the changes under the QPP visit the AANEM MACRA webpage:  http://www.aanem.org/Practice/Medicare/MACRA.  Please contact policy@aanem.org with any questions about MIPS.

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