Value-based care

Merit Based Incentive Payment System MIPS Performance Categories an Overview

By Seth Flam

Blog    Merit Based Incentive Payment System MIPS Performance Categories an Overview

In our last few blog posts, we’ve explained the two tracks through which to participate in the new CMS MACRA rule (MIPS or APMs), or Quality Payment Program – as well as who, exactly, is eligible for MIPS, since most practitioners won’t initially participate in the APM model.

As we've gone over, MIPS adjusts traditional fee-for-service payments upward or downward based on the new reporting program. This new program will integrate PQRS, Value-Based Payment Modifier and the EHR Incentive Program, which will end at the close of 2018. Parts of each of these previous programs will be streamlined into MIPS.

*Physicians can no longer opt out by paying a penalty – all providers who accept Medicare patients must comply.

So, How Exactly Are Physicians Measured?

Physicians under MIPS measured on four categories, each of which will carry a percentage, or weight, of the total score. MIPS scores will not only affect payment, but will also affect each clinician's reputation because they will be made public. Requirements of the performance categories will also account for differences among specialties.

The four performance categories are as follows:

  • Quality
    Clinicians will choose six measures to report to CMS that best reflect their practice.
    Counts for 50 percent of overall MIPS score.
  • Clinical practice improvement
    This is a new component, occurring for the first time at a national level. Clinicians can choose the activities best suited for their practice, out of more than 90 activities that have been proposed. *Clinicians participating in PCMHs will receive full credit in this category.
    Counts for 15 percent of overall MIPS score.
  • Resource Use (Cost)
    This doesn't require any reporting; CMS will calculate these measures based on Medicare claims.
    Counts for 10 percent of total MIPS score.

The total of these four weighted performance categories = A single MIPS composite performance score (CPS). The maximum negative and positive performance adjustments (incentives and penalties) will begin in payment year 2019 and increase every year after that.

Check back as we delve deeper into each performance category for MIPS and review the timeline.

Seth Flam, DO

CEO and President, HealthFusion