SLIDE 2
The performance of MIPS participants, referred to as Eligible Clinicians or ECs, is measured across the four weighted performance categories on a 100 point scale, called the Final Score, which is then compared against an annual performance threshold, with Medicare Part B reimbursement rates adjusted based on program performance. In 2018, the Quality performance category is worth 50% of the Final Score, Cost is worth 10% of the Final Score, the Improvement Activities performance category is worth 15% of the Final Score, and the Advancing Care Information performance category is worth 25% of the Final Score.
SLIDE 3
In the Improvement Activities performance category of MIPS, participants attest to having implemented activities that improve the clinical practice for a minimum of 90 days in the calendar year. There are currently 112 activities available to choose from which span the following 9 subcategories: Expanded Practice Access, Population Management, Care Coordination, Beneficiary Engagement, Patient Safety and Practice Assessment, Participation in an Alternative Payment Model, Achieving Health Equity, Integrating Behavioral and Mental Health and Emergency Preparedness and Response. The improvement activities for MIPS were based on the Patient Centered Medical Home model, so if you are familiar with that program, you will likely be familiar with the activity choices. Additionally, many clinicians, even those not practicing in Medical Homes, will likely identify activities on the list which have been previously implemented, sometimes years ago. Participants can get credit for previously implemented activities as long as the activity continues for a minimum of 90 days in the performance year.
SLIDE 4
Each of the 112 available activities is rated as either Medium weight, worth 10 points each or High weight, worth 20 points each. To maximize this category scoring, participants must earn 40 points, which can be achieved with any combination of Medium and High weight activities. There are, however, some additional flexibilities built into the program.
SLIDE 5
For groups with 15 or fewer participants, non-patient facing clinicians or groups, or if practicing in a rural or health professional shortage area, improvement activity point values are doubled, thus for these clinicians, category scoring can be maximized with 1 high weight activity or 2 medium weight activities. Additionally, clinicians practicing in all types of certified patient-centered medical homes, comparable specialty practices, or Alternative Payment Models designated as Medical Home Models automatically receive full credit in this MIPS performance category. Also, participants of a Medicare Shared Savings Program Track 1 ACO or the Oncology Care Model receive Improvement Activities category credit based on the requirements of participating in the APM. In 2018, this is full credit at 40 points. In future program years, this participation will be worth at least half credit.
SLIDE 8
In summary, the Improvement Activities performance category of MIPS is worth 15% of the Final Score in 2018. Clinicians choose from 112 activities spanning 9 subcategories. To qualify for points, the activities must be implemented for a minimum of 90 days in the program performance year. Clinicians can maximize category potential at 40 points with medium-weight activities worth 10 points each and high-weight activities worth 20 points. For groups with 15 or fewer clinicians, non-patient facing clinicians, or if practicing in a rural or health professional shortage area, activities are worth double points. Participants in certified Medical Homes automatically earn full category credit. Participants of MIPS APMs, including Shared Savings Program Track 1, automatically earn full category credit in 2018. In future years, this assigned score will be at least half credit.
Learn about the latest fee schedule changes moving from Fee for Service to Value or Quality based payment methodologies, via MACRA/ MIPS/ QPP.
To help clarify some of the terms surrounding Medicare Access and CHIP Reauthorization Act (MACRA), the AMA has compiled a list of acronyms, terms and definitions.
ABC™ - Achievable Benchmark of Care
ACO - accountable care organization
AHRQ - Agency for HealthCare Research and Quality
APM - alternative payment model
APRN - advanced practice registered nurse
ASPE - HHS’ Office of the Assistant Secretary for Planning and Evaluation
AUC - appropriate use criteria
BPCI - bundled payments for care improvement
CAH - critical access hospital
CAHPS - Consumer Assessment of Healthcare Providers and Systems
CBSA - non-core based statistical area
CDS - clinical decision support
CEHRT - certified EHR technology
CFR - Code of Federal Regulations
CHIP - Children’s Health Insurance Program
CJR - comprehensive care for joint replacement
CMMI - Center for Medicare & Medicaid Innovation (CMS Innovation Center)
CMS - Centers for Medicare and Medicaid Services
COI - collection of information
CPIA - clinical practice improvement activity
CPOE - computerized provider order entry
CPR - customary, prevailing and reasonable
CPS - composite performance score
CPT - Current Procedural Terminology
CQM - clinical quality measure
CY - calendar year
DPP - diabetes prevention program
eCQM - Electronic Clinician Quality Measure
ED - Emergency Department
EHR - electronic health record
EP - eligible professional
ESRD - End-stage Renal Disease
FFS - fee for service
FQHC - federally qualified health center
FR - Federal Register
GAO - Government Accountability Office
GPCI - Geographic Practice Cost Index
HAC - hospital-acquired condition
HCAHPS - Hospice Consumer Assessment of Healthcare Providers and Systems
HHS - Department of Health & Human Services
HIE - Health Information Exchange
HIPAA - Health Insurance Portability and Accountability Act of 1996
HITECH - Health Information Technology for Economic and Clinical Health
HOPD - Hospital Outpatient Department
HPSA - health professional shortage area
HRSA - Health Resources and Services Administration
IHS - Indian Health Service
IPAB - Independent Payment Advisory Board
IT - information technology
LDO - large dialysis organization
MA - medical assistant
MAC - Medicare Administrative Contractor
MACRA - Medicare Access and CHIP Reauthorization Act of 2015
MedPAC - Medicare Payment Advisory Commission
MEI - Medicare Economic Index
MIPAA - Medicare Improvements for Patients and Providers Act of 2008
MIPS - Merit-based Incentive Payment System
MLR - minimum loss rate
MSPB - Medicare spending per beneficiary
MSR - minimum savings rate
MU - Meaningful Use
MUA - medically underserved area
NCQA - National Committee for Quality Assurance
NPI - National Provider Identifier
NQF - National Quality Forum
OCM - Oncology Care Model
OIG - Office of the Inspector General
ONC - Office of the National Coordinator for Health Information Technology
PCMH - patient-centered medical home
PCORI - Patient-centered Outcomes Research Institute
PECOS - Medicare Provider Enrollment, Chain and Ownership System
PFPMs - physician-focused payment models
PFS - physician fee schedule
PHS - public health service
PPS - prospective payment system
PQRS - Physician Quality Reporting System
PTAC - Physician-focused Payment Model Technical Advisory Committee
QCDR - qualified clinical data registry
QIO - quality improvement organization
QP - qualifying APM participant
QPP - Quality Payment Program
QRDA - quality reporting document architecture
QRUR - quality and resource use reports
RAC - recovery audit contractor
RBRVS - Resource-based Relative Value Scale
RFI - request for information
RHC - rural health clinic
RIA - regulatory impact analysis
RVU - relative value unit
SGR - sustainable growth rate
TCPI - Transforming Clinical Practice Initiative
TIN - tax identification number
VBM - value-based payment modifier
VPS - volume performance standard