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

Academy Submits Comments on Episode-Based Cost Measures
On April 24, the Academy submitted comments to the Centers for Medicare & Medicaid Services (CMS) on CMS' Request for Information on Episode-based Cost Measure Development for the Quality Payment Program (QPP). CMS will incorporate cost measures into the cost performance category for MIPS for 2018 reporting. You can read the Academy's comment letter here

CMS Announces Initiative to Support Small Practices with MIPS Reporting
The Centers for Medicare & Medicaid Services (CMS) is offering small practices with 15 or fewer clinicians, including those in rural locations, health professional shortage areas, and medically underserved areas, support for reporting under MIPS in 2017. CMS has identified experienced local organizations that can help clinicians with the following:

  • Selecting and reporting appropriate measures and activities under each MIPS performance category
  • Engage in practice improvement
  • Optimize their Health Information Technology (HIT)
  • Evaluate options for joining an Advanced Alternative Payment Model (APM)

You can find the contact information for local technical assistance organizations and addtional resources here

Preparing for MIPS: HP Update Podcasts Released
The HP Update podcast features discussions on MIPS reporting in 2017, providing insights into how practices are preparing for the new program. 3P leaders, Robert Lorenz, MD, and Jane Dillon, MD, discuss the details of 2017 MIPS reporting requirements while Lance Manning, MD, explains how his private practice is preparing for MIPS. 

You can listen to the podcasts 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.