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MIPS Overview
iOSANDROID
WINDOWS
CRMMICROSOFT
SOCIALCRMDESIGN
EXPERIENCE
CLOUDJAVA RWD
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MACRA and MIPS MACRA replaces SGR. Two tracks – MIPS and Advanced Alternative Payment Models (APMs). Most clinicians will be under MIPS
MIPS ties PQRS, Value-based Modifier and EHR Incentive Program through a composite performance score
Year 1, 2 - Physicians, PAs, NPs, Clinical nurse specialists, Certified RN anesthetists. Eligible Clinicians group may broaden in future
Doesn’t apply to Hospitals or facilities, new Medicare enrollees, those below volume threshold and certain participants in the
Advanced APM models
50%
15%
10%
25%
Performance Category Weightage
Quality
CPI
Resource Use
Advancing care info.
2019 2020 2021 2022
4% 5% 7% 9%
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Advanced APMs Comprehensive ESRD Care Model (Large Dialysis Organization arrangement)
Comprehensive Primary Care Plus (CPC+)
Medicare Shared Savings Program—Track 2
Medicare Shared Savings Program—Track 3
Next Generation ACO Model
Oncology Care Model Two-Sided Risk Arrangement (available in 2018)
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Quality Performance Selection of 6 measures - individual measures or a specialty measure set. If <6 applicable, report on all those
1 cross-cutting measure and 1 outcome measure, or another high priority measure if outcome is unavailable
Individual reporting submission through QCDR, Qualified Registry, EHR Vendors, Administrative Claims (No submission required)
and Claims. Group reporting has CMS Web Interface (groups of 25 or more) and CAHPS in addition.
PQRS MIPS
Scoring Report all required measures to avoid payment adjustment
Report all required measures. Credit received for those measures that meet the data completeness threshold. Eligible clinicians performance will influence their score.
Data Submission Criteria Required 9 measures across 3 NQS domains Requires 6 measures; no NQS domain requirement
CAHPS requirement Required for groups with 100 or more EPs Not required but clinicians can receive bonus points for electing CAHPS
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For each measure CMS publishes deciles based on national performance in baseline period (2 years prior to perf. period)
Eligible clinician’s performance is compared to the published decile breaks and Each measure is converted to points (1-10)
0 points for each unreported but applicable measure;
For groups of 1-9 clinicians, CMS will calculate 2 population measures based on claims; For groups of 10+ clinicians, 3
Bonus points
– Additional high priority measures (up to 5% of possible total)
• 2 bonus points awarded for additional outcome/patient experience
• 1 bonus point for other high priority measures
– CEHRT Bonus (up to 5% of possible total)
• 1 bonus point for each measure reported using CEHRT for end-to-end electronic reporting
• Not available for claims
Quality Scoring
Decile 1 Decile 2 Decile 3 Decile 4 Decile 5 Decile 6 Decile 7 Decile 8 Decile 9 Decile 10
Possible points 1.0 - 1.9 2.0 - 2.9 3.0- - 3.9 4.0 - 4.9 5.0 - 5.9 6.0 - 6.9 7.0 - 7.9 8.0 - 8.9 9.0 - 9.9 10
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Calculation
Each measure is converted
to points(1-10)
Zero points for a measure
that is not reported
Bonus points: Outcomes,
patient experience,
appropriate use, patient
safety
Bonus points: EHR
reporting
48.2 31
52.2 70
Quality Performance Category Score = 74.6%
74.6 X 50% (weightage for QPC) = 37.3 points towards MIPS Composite score
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Advancing care info. Performance Category Clinicians must utilize the 2015 version of CEHRT by 2018 and report for full calendar year
Individual reporting through Attestation, QCDR, Qualified Registry and EHR. Group reporting has CMS Web Interface (>=25)
Medicare EHR Incentive Program Advancing Care Information Category
Every measure reported and weighed equally. Emphasizes information exchange, patient & family engagement, and security measures
Requires across-the-board levels of achievement or “thresholds,” regardless of practice or experience
Allows for diverse reporting that matches clinician’s practice and experience.
Disjointed and redundant with other Medicare reporting programs
Aligned with other Medicare reporting programs. No need to report redundant quality measures.
No exemptions for reporting Exemptions for reporting for clinicians in:• Advanced alternative payment models• First year with Medicare• Have low Medicare volumes
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Scoring
For full base score, providers must report either a “yes” for measures requiring a yes/no answer, or a nominator >=1 for the rest
Up to 80 points to providers who achieve performance on selected objectives and measures above the base score
Reporting to optional registries, (such as IRIS), fetches 1 bonus point toward ACI category score
Public Health and Clinical Data Registry Reporting Objectives to be ignored for specialties where those are irrelevant. Excluded
providers’ base scores will be determined on the remaining five objectives.
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Objectives & MeasuresObjective Measure Base score Performance score Example
Protect Patient Health Information
Conduct or review security risk analysis and implement security updates as necessary
Yes / No n/a Yes
eRx At least 1 permissible prescription transmitted electronically 1 patient n/a
Patient Electronic Access
At least 1 unique patient/family rep provided timely e-access to their health information
1 patient % of patients 95%
At least 1 unique patient provided e-access to patient-specific educational materials
1 patient % of patients 65%
Coordination of Care through Patient Engagement
At least 1 unique patient / family rep actively engages with EHR via VDT or API
1 patient % of patients 35%
Secure message sent (or responded to) for at least 1 unique patient / family rep
1 patient % of patients 31%
PGHD or data from non-clinical setting incorporated into CEHRT for at least 1 unique patient
1 patient % of patients 25%
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Objectives & MeasuresObjective Measure Base score Performance score Example
Health Information Exchange
At least 1 transition of care / referral summary of care (SOC) is created & e-exchanged
1 patient % of patients 21%
At least 1 transition of care / referral summary of care (SOC) is e-received and incorporated
1 patient % of patients 38%
At least 1 transition of care / referral clinical information reconciliation is performed for (1) Meds (2) Med allergies AND (3) Current problem list
1 patient % of patients 57%
Public Health and Clinical Data Registry Reporting
Immunization registry reporting (plus 4 optional registries) Yes / No n/a Yes
Base score 50%
Performance score 9.5% + 6.5% + 3.3% + 3.1% + 2.5% + 2.1% + 3.8% + 5.7% = 36.5%
Bonus point (PHR, CDR reporting) 1%
Total ACI score = 87.5% 87.5 X 25% (weightage for ACI) = 21.88 points towards MIPS Composite score
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Clinical Practice Improvement Minimum selection of one CPIA (from 90+ proposed activities) for a partial score, with additional scoring for more activities
Activities categorized as “high” or “medium” weight, earning 20 or 10 points each, respectively
Full credit is achievement of 60 points - PCMHs, Medical Home, or comparable specialty practice receive that by default
Minimum of half credit for APM participation, with opportunity to select additional activities for full credit
For non-patient facing eligible clinicians and groups, small practices (<=15 professionals), practices in rural and health professional
shortage areas:
– First activity gets 50% of the 60 points
– Second activity gets 100% of the 60 points
In year 1, all MIPS eligible professionals to designate a yes/no response for activities on the CPIA Inventory. For 3rd party
submission, MIPS eligible clinicians or groups will certify all CPIAs have been performed and the health IT vendor, QCDR, or
qualified registry will submit on their behalf.
The administrative claims method is proposed, if technically feasible, to supplement CPIA submissions.
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Clinical Practice Improvement
Sample Calculation
Completion of 2 high weight activities (40 points) and one medium weight activity (10 points) would imply a total of 50 points
Maximum possible points 60 points
CPIA category score 83% 83 X 15% (weightage for CPIA) = 12.5 points towards MIPS Composite score
Expanded Practice Access Care Coordination Patient Safety & Practice
Assessment
Population Management
Beneficiary Engagement
Participation in APM including medical home model
Activity categories
For a detailed list of activities, please visit this page.
Achieving Health Equity
Emergency Preparedness and
Response
Integrated Behavioral and Mental Health
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Resource Use Scored at the individual NPI level or as a group; Patient attribution methodology remains the same as in VBPM
Calculates scores based on Medicare claims, meaning there are no additional reporting requirements for clinicians
Each measure worth 10 points and applicable for a minimum of 20-patient sample; No bonus points
Measures
– Medicare Spending per Beneficiary (MSPB) : Combined Part A & B spend for a patient during a time interval that starts 3 days before
admission and ends 30 days post-discharge
– Total per capita cost : Evaluates overall efficiency of care provided to beneficiaries attributed to practitioners identified by TIN
– Over 40 episode-based measures will be used to evaluate resource use as applicable
Points assigned against benchmark based on deciles(for the performance period)
The category score would be average of scores for all applicable measures
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For more information, contact [email protected]
Nalashaa Solutions llc.555, US Highway One South, Ste 170, Iselin, NJ 08830 +1-732-602-2560 Ext: 200
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