The new MIPS program uses both the carrot (payment increases) and the stick (penalties)
The CMS “incentive” programs over the past several years — Meaningful Use, PQRS, ePrescribing, and the Value-modifier — have been used both the “carrot” and “stick” approach. CMS provides both cash bonuses and penalties.
The Merit-based Incentive Payment System or MIPS was created as a way to simplify the procedural process for clinicians. Over the past several years, physicians and clinicians have been subject to the EHR Incentive Program for EPs (Meaningful Use), the Physician Quality Reporting System (PQRS), and the Value-based Payment Modifier (VM). At the end of 2016 these programs will sunset for practices and clinicians and will be morphed into MIPS.
MIPS will apply a payment modifier (either a bonus or a penalty) for each reimbursement. The payment modifier will be based on the practice’s performance 2 years prior. The first payment year of MIPS will be 2019, based on the practice’s performance during 2017.
The MIPS payment modifier is determined by a Composite Performance Score (CPS) defined from 4 performance categories. The Quality performance category replaces PQRS and the quality factor of VM. The Resource Use performance category replaces the cost factor of VM. The Advancing Care Information performance category replaces Meaningful Use. The Clinical Practices Improvement Activities (CPIA) performance category is new, but it accounts for activities that practices are already doing to improve the quality/opportunity of care.
The CPS takes a weighted value from each of these performance categories to determine the payment modifier for the clinician or practice. The performance threshold is set the year previous to the performance year so clinicians can be prepared for the score they need to achieve.
Stay tuned to future blog posts discussing: reporting, scoring, performance categories, and how to position your practice to succeed with MIPS.
Editor’s Note: Subsequent to the publication of this article, CMS has renamed the “Meaningful Use” programs and MIPS “Advancing Care Information” category to “Promoting Interoperability”.
