What is MIPS?
MIPS stands for Merit-based Incentive Payment System. MIPS is part of the Centers for Medicare and Medicaid’s (CMS) Quality Payment Program (QPP). QPP rewards eligible clinicians for achieving high performance on measures across the different categories set by CMS. This program encourages the transition away from fee-for-service models towards value-based healthcare models.
Value-based healthcare is a paradigm shift that rewards clinicians for the quality of care they provide to patients as opposed to fee-for-service care where a patient is charged each time they see a doctor. This shift applies to all size practices, whether they’re small practices, hospitals, or individual clinicians. When healthcare clinicians focus on administering quality care to their patient populations they help prevent expensive emergency room visits and hospital readmissions. The MIPS program rewards clinicians for that quality service based on the measures data they collected within a specified performance period. MIPS also encourages the increased use of a Certified Electronic Health Record (CEHRT) system.
MIPS Performance Categories
MIPS Performance is measured by data recorded and reported in four categories: Quality, Promoting Interoperability (PI), Cost, and Improvement Activities. Previous healthcare programs such as Medicare Electronic Health Records (EHR) Incentive for Eligible Clinicians, Physician Quality Reporting System (PQRS), and the Value-Based Payment Modifier (VBM) have all been consolidated under MIPS. These measures are established by CMS. There are over 250 MIPS measures available to report on for 2019.
Quality: The Quality performance category has replaced PQRS. It represents the quality of care delivered to a patient based on CMS performance measures.
Promoting Interoperability (PI): Previously known as the Advancing Care Information category, Promoting Interoperability (PI) focuses on patient engagement and the electronic exchange of health information. The information exchange must be facilitated by certified electronic health record technology (CEHRT). PI has replaced the Medicare EHR Incentive Program, commonly referred to as Meaningful Use.
Cost: The Cost performance category replaces VBM. This category is calculated based on a clinician’s CMS Medicare claims and the cost of care provided. MIPS employs this category to understand the total cost of care throughout the year and counts towards overall score calculation.
Improvement Activities: This category covers a host of activities, including how clinicians improve their care processes, patient engagement, and increased access to care.
Tips for Raising Your MIPS Score
Every clinician wants to maximize their MIPS incentive payments, reaping the rewards of hitting measures benchmarks. Sometimes this can be more complex than it seems. Here are some tips on how to improve MIPS scores.
1) Make sure you’re eligible for QPP Participation
2) Know the weight of each category
Each of the four performance categories has a different weight when calculating the final MIPS score for the year. These weights can change each year. For 2019, the four categories are weighted as follows: Quality - 45%; Promoting Interoperability - 25%; Improvement Activities - 15%; Cost - 15%.
3) Plan ahead
A little planning can go a long way. Figure out what measures you want to report on and formulate a plan to tackle them with your patient population.
4) Understand your patient population
For clinicians that serve high-risk/high-cost patients, understanding the patient population and what measures would have the largest impact is key for hitting benchmarks.
5) Using a certified electronic health records (CEHRT) system can net you bonus points
The Office of the National Coordinator for Health IT (ONC) updated the certification criteria for EHRs in 2015. If you hit the three points on the HealthIT.gov Quality Measures Reporting page, you can get a bonus of up to 10% of the Quality category score. A higher score means higher reimbursements!
6) Don’t be wed to the measures you’re already performing well on because measures can top-out.
Measures can top-out, and new for 2019, measures can be extremely topped-out. But what does that mean? Measures are considered topped-out when CMS deems that these are measures on which clinicians are performing well consistently. Quality measures are awarded between 3 - 10 points depending on the decile per measure. Topped-out measures are only worth up to 7 points. Even if a clinician performs exceptionally well on a topped-out measure, they can only obtain a maximum of 7 points.
7) Using a registry can help you get a better score.
A bulk of MIPS submissions are done through certified electronic health record technology (CEHRT). You may be able to boost your score by engaging one of the qualified registries. Qualified registries (such as Healthcare Innovation Solutions, Inc., a subsidiary of the New Jersey Innovation Institute) are entities that are authorized by CMS to submit Quality Measures, Promoting Interoperability (PI) Measures, and/or Improvement Activities. Qualified registries submit this data on behalf of eligible clinicians and groups for MIPS reporting.
A benefit of submitting your data through a registry as opposed to an EHR is that registries can submit data on measures EHRs are not certified to report on. This opens up a host of new measures that were previously inaccessible. In addition, submitting through a registry means less work for your staff. The registry collects and prepares all the pertinent measures data for MIPS submission.
8) Run frequent reports to identify gaps in care.
One of the best ways to ensure you’re hitting measures benchmarks is running frequent reports. When you know where you stand on each measure, you’re empowered to address gaps in patient care. Maximizing your reimbursements requires an understanding of your patient data and of the benchmarks for each measure you’re pursuing. An easy way to collect all your data into one place is using Measures Manager™.
Measures Manager™ aggregates all of your relevant EHR data into one streamlined dashboard. This top-down view provides an overview of how you’re performing on the value-based contracts you’re pursuing. This applies to government contracts as well as supported contracts through private insurers. Measures Managers™ shows how you’re performing against the quality measure being pursued. This makes identifying gaps in care and measures easy to find and ultimately leads to better patient care and outcomes for your patient populations.
Measures Manager™ can be employed by individual clinicians or groups, including accountable care organizations (ACO), clinically integrated networks (CIN), or hospitals. By collecting data from different sources into one place, Measures Manager™ makes sense of your data through simple charts and graphs. You can easily see how you’re performing against measures benchmarks for several different contracts in one place.
Measures Manager™ also offers powerful filtering tools to aid in gap closure. You can identify exactly which clinicians are performing well on their measures gap closure and which are not. With this data in hand, you’re able to take action before it’s too late. You can also view data on how practices within your organization are performing overall against measures benchmarks.
But it’s not only clinicians and practices you can view data on! Measures Managers™ allows you to filter down to the patient level. This degree of information empowers clinicians through data. With this filter, you can see what patients are eligible for what contracts. You can also see where each patient falls on a measure within those contracts they’re being tracked for. An embedded planning tool allows you to group patients together, making population health management and closing measures gaps even easier.