The Merit-based Incentive Payment System (MIPS) consolidates three existing quality reporting programs: the Physician Quality Reporting System (PQRS), the Value-Based Payment Modifier (VBPM), and EHR Meaningful Use (MU). The system also adds a new program, Clinical Practice Improvement Activities (CPIA). The four programs establish a composite performance score (0-100) used to determine physician payment. The categories are:
- Quality – based on the Physician Quality Reporting System;
- Resource use – based on the Value Based Payment Modifier;
- Meaningful use of certified electronic health record (EHR) technology – based on Meaningful Use; and
- Clinical Practice Improvement Activities – a new program.
While the first year for the Medicare Access and CHIP Reauthorization Act is 2019, the performance period is 2017 (unless modified in the final rule). Thus, performance in 2017 will determine payment adjustments in 2019. Accordingly, providers should begin preparing now for implementation to ease the transition and position themselves for success.
Determine if you are excluded from the Merit- based Incentive Payment System participation via the low-volume exclusion threshold. Clinicians or groups who have less than or equal to $10,000 in Medicare charges and less than or equal to 100 Medicare patients are excluded from the MIPS payment adjustment.
Understand the assistance available for small practices. There is $20 million a year allocated to provide technical assistance via Quality Improvement Organizations and Regional Extension Centers to practices with 15 or fewer eligible professionals participating in an Alternative Payment Model or the Merit-based Incentive Payment System. This assistance is intended to position practices to transition to Alternative Payment Models or to improve Merit-based Incentive Payment System composite scores. Priority will be given to practices in rural areas, health professional shortage areas, and medically under-served areas.
Determine if you will report individually or as a group. The law provides that solo and small practices may join “virtual groups” in the future and combine their Merit-based Incentive Payment System scoring.
Determine whether your practice meets the requirements for small, rural, or health professional shortage area practices. These types of practices would receive partial or full credit for submitting two activities of any type of weighting (e.g., two medium-weighted activities will qualify for full credit).
Determine if you are a non-patient-facing Merit- based Incentive Payment System eligible clinician. The Medicare Access and CHIP Reauthorization Act requires the Centers for Medicare and Medicaid Services, in specifying measures and activities for a performance category, to give consideration to the circumstances of professional types who typically furnish services that do not involve face-to-face interaction with a patient (e.g., pathologists, radiologists, nuclear medicine physicians, anesthesiologists primarily providing oversight of Certified Registered Nurse Anesthetists). The law allows the Centers for Medicare and Medicaid Services to re-weight the Merit-based Incentive Payment System performance categories if there are not sufficient measures and activities applicable and available to each type of Merit-based Incentive Payment System eligible clinician.
The Centers for Medicare and Medicaid Services proposes to define a “non-patient-facing Merit-based Incentive Payment System eligible clinician” as an eligible clinician or group that bills 25 or fewer patient-facing encounters during a performance period. The Centers for Medicare and Medicaid Services proposes to publish a list of “patient-facing encounter” codes on its website, similar to the way it currently publishes face-to-face encounter codes for the Physician Quality Reporting System.
Assess your performance under current federal quality reporting programs. Performance in the Physician Quality Reporting System, Meaningful Use, and the Value-Based Payment Modifier will provide insight into future performance under the Merit-based Incentive Payment System.
Evaluate Electronic Health Record and third-party vendor readiness. Contact your vendors to assess their ability to support the transition to the Merit- based Incentive Payment System.
Explore clinical practice improvement opportunities. Review the proposed rule’s list of clinical practice improvement activities to evaluate what activities your practice is already doing and what adjustments it should make to complete additional activities in 2017. Practices will be given credit in the Merit-based Incentive Payment System for activities such as extending hours and managing transitions of care.
Miranda Franco is senior public affairs adviser for Holland & Knight LLP. Questions or comments related to this article should be directed to Miranda.Franco@hklaw.com.