MIPS

The MIPS Value Pathways (MVPs) is a new reporting structure available for the Merit-based Incentive Payment System (MIPS).  The MVP framework is intended to ease the reporting burden on clinicians and groups by aligning measures and activities across the Quality, Cost, and Improvement Activities categories of MIPS that are more relevant to a clinician’s scope of practice. This article answers key questions about MVPs and how MIPS reporting is expected to change in the years ahead.  

The U.S. healthcare system has long struggled with establishing an efficient and effective process for storing and sharing patients’ medical information, but the adoption of the Fast Healthcare Interoperability Resources standard, known as FHIR, is now paving the way for transformative change in this area. FHIR is not only a solution for the seamless exchange of health information but also can alleviate the burden on providers who need to adhere to various quality data reporting mandates. In this article, we'll explain what FHIR is, how it can ease quality data reporting compliance in programs like the Merit-based Payment Incentive System (MIPS) and the Alternative Payment Model Performance Pathway (APP), and what healthcare providers can do today to connect with FHIR.

The use of technology has become an essential aspect of our daily lives, and the healthcare sector is no exception. Nowadays, clinicians and their practices require reliable and secure methods to collect and store patient data. As a result, an increasing number of clinicians are turning to electronic health record (EHR) systems. Over time, EHR technology has evolved, leading the Office of the National Coordinator for Health Information Technology (ONC) to implement a set of national standards for the secure access, exchange, and use of electronic health information that EHRs must comply with to attain voluntary certification. MDinteractive is an ONC-certified health IT vendor and CMS qualified registry. This article describes the ONC certification process and the benefits of using certified EHR technology.

The MIPS Promoting Interoperability (PI) category, which replaced the Meaningful Use program, establishes requirements that promote the electronic exchange of information using certified electronic health record technology (CEHRT). MIPS eligible clinicians and groups are scored on their performance on several PI measures. The last day to start a minimum 90-day reporting period to attest to PI is October 3, 2022. Making sense of all of the requirements can be challenging, so let’s examine how to report the PI category and the potential impact on the MIPS final score.

Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program will have new reporting requirements beginning in 2025. The Centers for Medicare and Medicaid Services (CMS) has established a multi-year transition period to change the data that these organizations must report and how the data gets submitted. The changes are intended to reduce reporting burdens and improve patient outcomes. Partnering with a CMS Qualified Registry like MDinteractive can ease the transition for ACOs and help them meet their data reporting needs. 

Technology has transformed how consumers perform a variety of daily activities and transactions. With a computer or smartphone, they can buy tickets and book travel, access their bank accounts, use GPS map assistance and so much more. Unfortunately, they don’t have the same flexibility when it comes to healthcare. This is changing, however, with the development of a new standard for exchanging electronic healthcare information called the Fast Healthcare Interoperability Resource, or FHIR (pronounced “fire”).  

The MIPS Cost category weight is increasing to 20% of a clinician’s final MIPS score in 2021 and 30% in 2022. The increase reflects the priority that the Center for Medicare and Medicaid Services (CMS) has placed on controlling the cost of health care services as a component of the MIPS program. As Cost makes up a larger portion of the total MIPS score, it’s beneficial to understand how CMS measures Cost. Let’s review the basic components of the Cost category and examine strategies to manage and potentially improve performance.

MIPS eligible clinicians, groups and virtual groups can now apply for the 2020 Promoting Interoperability (PI) Hardship Exception or the MIPS Program Extreme and Uncontrollable Circumstances Exception. Applications must be submitted to CMS by December 31, 2020. Exceptions will be available to those who meet certain criteria established by CMS. Those who qualify for automatic reweighting of PI reporting do not need to apply for this exception.

Cost is the fourth performance category under the MIPS program and makes up 15% of your total MIPS score for 2019 (up from 10% in 2018 and 0% in 2017). This category will steadily increase to 30% by the year 2022 when it will have the same weight as Quality. If CMS is unable to calculate a Cost score for a clinician, the category will be reweighted to Quality. While clinicians can relatively quickly change their MIPS Quality score by tracking some specific outcomes (e.g., track smoking status and give cessation advice), Cost is more challenging. It is more complex with many different variables, so monitoring Cost becomes important as it contributes more towards your final MIPS score. MDinteractive can help you access your CMS performance feedback reports which will provide your Cost score from prior MIPS reporting years.  In this article we will explore the different cost measures, how they are scored and the potential impact on your practice.

With another MIPS performance year behind us, it is not too early to start thinking about a reporting strategy to ensure MIPS success for 2019. This year CMS is providing new flexibility to report quality measures through multiple submission methods which can help improve MIPS scores and increase incentive payments. In this article we demonstrate how combining registry and EHR measures will help specific clinicians with their MIPS reporting. The strategy would not only boost their MIPS scores, but it would also increase their Medicare payments by thousands of dollars.