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What Changes will MIPS, MACRA Bring for Clinical Quality Reporting?

MIPS will bring some changes to meaningful use, PQRS, and the Value-Based Modifier.

- New healthcare payment models are upon us as the Merit-Based Incentive Payment System (MIPS) changes the way in which Medicare providers earn incentive payments.

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Set as a part of the Medicare Access and CHIP Reauthorization Act (MACRA), MIPS will reassess hospital and provider quality by replacing the sustainable growth rate (SGR) formula.

But what exactly is MIPS, and what kinds of specific changes will it bring? EHRIntelligence.com has broken down this new payment system, detailing what changes are to come and for whom they will have effect.

What is MIPS?

As stated above, MIPS will replace the SGR for Medicare hospitals and providers. By using three pre-existing performance models, providers will be scored on a scale of zero to 100, and the score will correlate to a provider’s incentive payment.

Specifically, MIPS will distribute their scores amongst the three performance measures as follows:

  • Meaningful use: 25 points
  • Physician Quality Reporting System/Value-based Modifier: 30 points
  • Value-based Modifier Cost: 30 points
  • Clinical Practice Improvement: 15 points

Who qualifies for MIPS?

Those eligible for MIPS changes as time goes forward. In the program’s first year, physicians, physician’s assistants, nurse practitioners, clinical nurse specialists, and nurse anesthetists all qualify for the program.

Starting in 2019, more healthcare specialists qualify for the program, including physical and occupational therapists, speech-language pathologists, audiologists, nurse midwives, clinical social workers, clinical psychologists, and dieticians.

As stated above, MIPS is a payment incentive program for Medicare Part B providers.

EHR Incentive Program

The first of the MIPS performance measures is the Centers for Medicare & Medicaid Services EHR Incentive Programs, worth a total of 25 points.

As the program stands currently, Stage 2 Meaningful Use is underway for the most recent reporting period, and Stage 3 Meaningful Use will go as planned in the optional start year of 2017 and the required start year of 2018.

However, earlier this year CMS’s Andy Slavitt announced that the agency is planning on significant changes to the program, specifically in anticipation of the start of MACRA and MIPS.

“The CMS meaningful use program as it has existed will now effectively be over, and replaced with something better,” Slavitt said at the JP Morgan Healthcare Conference.

Healthcare experts agree that putting meaningful use in the context of an incentive payment program such as MIPS is the best way to ensure high provider performance.

“More Meaningful Use and Certification criteria are not the answer,” wrote CIO of Beth Israel Deaconess Medical Center John D. Halamka, MD, MS. “Paying for outcomes that encourage government, payers, providers, patients and health IT developers to work together, instead of being adversaries, is the path forward.”

Physician Quality Reporting System

The Physician Quality Reporting System (PQRS) is a system by which physicians can measure the quality of care they are provider to patients on an individual level.

By adding PQRS to other quality reporting measures, CMS hopes to reduce duplicative measures, and streamline the entire process for merit-based incentives.

However, some experts say that this is opening up some gaps in reporting. According to the National Quality Forum, these measures need to better take into account patient preferences during quality reporting.

In particular, MAP members noted the need for patient-centered measures, including patient-reported outcome measures, functional status measures, care coordination measures, and measures that incorporate patient values and preferences. MAP noted that the principle of patient preference could apply not only to new measures, but also to existing measures, which could potentially be modified to include outcomes or processes that reflect patient preferences and shared decision-making.

Value-Based Modifier

The Value-Based Modifier compares the value of care provided to the cost of that care provided, and helps CMS determine the Medicare Physician Fee Schedule.

The reporting done during calendar year 2016 will be used to determine the Value-Based Modifier for 2018, the year in which MACRA and MIPS begin. Using a tiered model, CMS will determine whether a physician or group practice receives a positive, negative, or neutral payment adjustment under the Value-Based Modifier.

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