Brace yourself: Changes to MIPS are coming Print
Written by Accountable Care Options, LLC   
Thursday, 27 October 2016 07:06

For physicians trying to keep pace with all the health care changes and practice transformations, planned modifications to the Merit-Based Incentive Payment System (MIPS) could make life a little easier next year.

MIPS takes parts of the Physician Quality Reporting System (PQRS), the Value Modifier and the Medicare Electronic Health Record (EHR) incentive program and puts them into a single new program. Rather than rush physicians into new rules, the Centers for Medicare and Medicaid Services (CMS) has proposed a phase-in option. The details are still fuzzy, but if a physician practice reports some form of quality data electronically in 2017, it will avoid a penalty and later have an opportunity for incentives on Medicare Part B payments.

MIPS looks at four areas: quality; advancing care information; clinical practice improvement activities; and cost. Under the new plan, a practice won’t initially have to show that it was meeting those measures in 2017, just show that for a certain portion of the year it was submitting data.

In phase one, a practice will report meaningful use using an EHR that's certified at 2014 standards and will provide PQRS attestation. In phases two and three, the practice will submit those elements again and add resource use.

The move to MIPS is part of CMS’ efforts to incentivize practices to move along the same path as everybody else and become more efficient. The agency is seeking ways to reduce unnecessary health care spending on patient populations by finding high-quality and efficient partners.

Under the program, a practice with cost measures such as per-patient per-month or per-patient per-year spending that are far above those of its peers in a particular specialty will see a negative effect on its Medicare payments. If the measures are below average, the practice can be eligible in 2019 for incentives based on performance in 2017. The rules change in 2018.

CMS is also looking for meaningful reductions in costs, meaning not only expenses are going down, they’re moving below those of a practice’s peers. The agency makes the determination based on data it collects and publishes online in CMS quality and resource use reports.

Separately, practices submit data on how they are transforming or improving themselves using criteria such as being flexible in appointments and offering same-day, evening and weekend access. Physicians are evaluated on how well individualized care plans maintain or improve patient health.

The results will determine the size of the payment adjustment in phases two and three. It will be mild and modest at the beginning, CMS says. That figure, which would increase or decrease payments, could be around 4 percent in 2019, rising to 5 percent the next year and to 9 percent in 2022.