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 Cost performance category of MIPS, worth 10% of the MIPS Final Score in 2018, there is no additional reporting requirement. Clinicians and groups will be assessed in this performance category based on Medicare Part B claims data received through the normal claims process, otherwise known as Administrative Claims analysis. For this performance category, keep in mind that it uses measures previously used in the Value-based Modifier program and reported in Quality and Resource Use Reports or QRURs. Only the scoring is different.
SLIDE 5
When developing cost measures, CMS considers five essential components. First, defining an episode group. An episode group is a certain type of procedure such as aortic valve replacement or hip fracture surgery. In general, there are 3 different types of episode groups which CMS intends to further develop with significant healthcare community feedback, Chronic Condition Episode Groups, Acute Inpatient Medical Condition Episode Groups and finally, Procedural Episode Groups. Through further development and stakeholder feedback, CMS will be developing additional cost measures which will be used in future years of the program. The second component in developing a cost measure deals with assigning costs to the episode group. Both direct and indirect costs are considered here and assigned appropriately. Number 3 is attributing the episode group to one or more responsible clinicians. Number 4 includes risk adjusting the episode group resources or defining episodes to compare like beneficiaries, which is needed to ensure there is an apples-to-apples comparison to the greatest extent possible. And finally five, aligning episode group costs with indicators of quality, so that clinicians can pursue high quality and lower costs concurrently.
SLIDE 6
Why are cost measures important? CMS’ goal for developing cost measures is to provide actionable information that is USEFUL to clinicians and, together with the other components of MIPS, drive lowered costs and improved patient outcomes. Overall, CMS seeks to provide clinicians with information to reduce healthcare spending and promote the delivery of high-value care.
SLIDE 7
In summary, the Cost performance category of MIPS replaces the cost portion of the Value Modifier program and is worth 10% of the MIPS Final Score in 2018. The weight of this performance category will increase in subsequent years, eventually being equally weighted with the Quality category at 30% each. No additional data reporting is required in this category as measurement is calculated from claims data. Cost measures represent payments for the items and services furnished to a Medicare beneficiary during an episode of care. And CMS’ goal in developing cost measures and providing actionable data to clinicians is to reduce healthcare spending and promote the delivery of high-value care.
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