Merit-based Incentive Payment System

Merit-based Incentive Payment System

The Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) replaced the Sustainable Growth Rate (SGR) and created the Merit-based Incentive Payment System (MIPS).

MIPS Image

Clinical Practice Improvement Activities and Measurement Study
CMS recently announced a new Clinical Practice Improvement Activities and Measurement Study. MIPS Eligible Clinicians (ECs) and groups who complete the study will receive full credit for the MIPS Improvement Activity performance category.

Study participants will be required to complete the following actions by December 2017:

  1. Fill out at least three surveys;
  2. Participate in at least three focus groups; and
  3. Send CMS at least three clinician quality performance measures.

Applications for the study close January 31, 2017. To apply, download the application here and email the completed application to CMSCPIAStudy@ketchum.com.

Learn more about the study intent and process here.

Academy Comments on MIPS and APM Final Rule
On December 19, the Academy submitted comments to Centers for Medicare & Medicaid Services (CMS) in response to the Merit-based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Final Rule. The Academy commented on the reduced reporting requirements for the transition year; MIPS performance category criteria and scoring; Qualified Clinical Data Registry (QCDR) and quality measure reporting requirements; and applicability of APMs to Otolaryngologists - Head and Neck Surgeons. Access the comments

Academy Factsheets on the New MIPS and APM Programs
To assist Members with MIPS and APM reporting, the Academy has created fact sheets providing an overview of each program including MIPS reporting categories and Advanced APM eligibility criteria. 

MIPS Background

Starting January 1, 2017 eligible clinicians (ECs) will report under MIPS. Unless they qualify for an exemption, do not meet the minimum reporting threshold, or are part of an Advanced APM, all physicians, physician assistants, nurse practitioners, clinical nurse specialists, or certified registered nurse anesthetists who bill Medicare are considered ECs and must participate in MIPS.

For the 2017 reporting period, clinicians have the option to pick their pace with three reporting periods for MIPS:

  • Test Pace: Report some data in 2017.
    • 1 quality measure, or 1 improvement activity, or 4/ 5 required advancing care information (ACI) measures.
  • Partial MIPS Reporting: Report one or more MIPS performance categories for at least 90 consecutive days in 2017 (must begin reporting by October 2, 2017).
    • 1+ quality measure, or 1+ improvement activities, or 4/ 5 required ACI measures
  • Full MIPS Reporting: Report all MIPS categories for at least 90 consecutive days in 2017 (must begin reporting by October 2, 2017).

ECs will report on three categories that will add up to a composite performance score (CPS). The CPS will be used by CMS to determine whether or not an EC will receive a bonus payment or will be subject to a payment reduction. The 2019 payment adjustments will be based on 2017 reporting. Learn more about the MIPS program here

MIPS Payment Update Table
Annual Payment
Update
Adjustment
Factor
Additional
Incentive Payment
Adjustments
2019 (based on 2017 reporting)
0.5%+- 4%≤10%
2020 (based on 2018 reporting)
0%+- 5%≤10%
2021 (based on 2019 reporting)
0%+- 7%≤10%
2022 (based on 2020 reporting)
0%+- 9%≤10%
2023 (based on 2021 reporting)
0%+- 9%≤10%
2024 (based on 2022 reporting)
0%+- 9%≤10%
2025 (based on 2023 reporting)
0%+- 9%0
2026+
0.25%00

MIPS CPS

A physician's MIPS CPS will incorporate four distinct categories: Quality; Advancing Care Information (ACI); Improvement Activities; and Cost.

Quality

  • 60% of the total score in year 1 (CY 2019, based on 2017 reporting).
  • Learn more here

ACI

  • 25% of the total score in year 1 (CY 2019, based on 2017 reporting)
  • Learn more here.

Improvement Activities

  • 15% of the total score in year 1 (CY 2019, based on 2017 reporting).
  • Learn more here.

Cost

  • 0% of the total score in year 1 (CY 2019, based on 2017 reporting).
  • Learn more here.