The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is intended to rapidly push the transformation of the US healthcare system toward performance-based payment models across both government and commercial payers. The law provides strong incentives to physicians for participation in Medicare risk-sharing Alternative Payment Models (APMs). For physicians who choose not to become involved in APMs, they will be required to report and perform well on four categories – quality, resource use, health information technology use, and clinical practice improvement – in the new Merit-based Incentive Payment System (MIPS).
Bearing risk and reporting on clinical performance requires the ability to collect, analyze and report on clinical performance data. Whether it is identifying high cost patients, reducing readmissions and adverse events, coordinating care and managing resource use, or accurately reporting quality measures to various registries and payers, clinicians will need to make better use of health information technology to help them avoid financial penalties and allow their practices to prosper in the new environment.
ARE YOU READY? Take the MIPS Quiz
Can you meet the following MIPS-related requirements?
- Are you participating in a health information exchange?
- Do you know who your high risk and rising risk patients are?
- Are you gathering data from all of your patient’s providers to improve your quality scores?
- Do you know your patient’s emergency department utilization?
- Do you electronically report to the state immunization registry?
- Do you have strategies in place to reduce healthcare utilization for your patients?
Based upon the new Merit-based Incentive Payment System (MIPS), there is revenue to be gained or revenue at
risk based upon how you perform. If, for example, you receive $200,000 in Medicare Reimbursement annually, the
financial impact according to the MIPS schedule is as follows the first year:
KHS provides you with the tools necessary to CONNECT. ANALYZE. ENGAGE. TRANSFORM.
MIPs is the new proposed payment program from CMS designed to streamline three already existing independent programs (quality, resource use and improvement activities) and combine them with a fourth program to promote improvement and innovation of clinical activities (Advancing Care Information). Clinicians have the flexibility to choose the activities and measures that are most meaningful to their practice and then demonstrate performance. Year one Composite Performance Score category weighting: Quality 60%, Advancing Care Information 25%, Improvement Activities 15%.
Quality = 60% of MIPS Score
- Influenza Immunization
- Pneumococcal Vaccination
- Osteoporosis Screening
- Breast Cancer Screening
- Diabetes A1c > 9
- Colorectal Cancer Screening
- Cervical Cancer Screening
Advanced Care Information = 25% of MIPS Score
- Secure Clinical Messaging/DIRECT
- HIE Longitudinal Patient View
- Within EHR
- Web-based Access
- ONC Certified Personal Health Record
- View Download & Transmit (VDT)
- Patient Education
- Secure Messaging
- Public Health Interfaces
- Syndromic Surveillance
- Diabetes Clinical Data Registry
Improvement Activities = 15% of MIPS Score
- Participate in HIE
- Participate in Research
- Regular Reviews of Targeted Patients
- Empanel Patients for Providers
- Proactively Manage Patient Care
- Identify High Risk Patients
- Improve Health Status of Communities
- Measure and Improve Quality
- Patient Portal
- Patient Education Materials
- CLICK HERE to access physician payment reform resources from the AMA.
- CLICK HERE to access physician payment reform resources from CMS.
- CLICK HERE to access the KHS MIPS Quiz.