On October 14, 2016, the Department of Health and Human Services (HHS) issued its final rule implementing the Quality Payment Program that is part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) ending the sustainable growth rate formula. Under the law new payment methods will be developed and implemented rewarding providers for value over volume.
The 2017 Quality Payment Program replaces the existing Quality Reporting Program of previous years. For an overview of the program, click on the document link: Overview 2017 Quality Payment Program.
MIPS requirements vary by performance category
MIPS is comprised of four connect pillars that will affect how you will be paid by Medicare (Quality, Advancing Care Information, Improvement Activates and Cost). Each performance categories have separate reporting requirements and associated maximum point totals.
2017 Quality Measures:
PQRS measures are redefined under MIPS as Quality measure. Individuals report up to 6 measures, including an outcome measure at least 50% of the time the measure applies. At least 20 cases in the denominator, for a minimum of 90 days. The 6 measures reported in 2017 will count from 3 to 10 points. Your score will increase based on the overall cases in the denominator and the increase in reporting performance above 50%. Quality measures reporting methods are:
- Claims-based reporting
- Qualified Data Registry
- Qualified Registry
There are 271 Quality Measures to choose from, specification for 11 possible measures are listed below.
Quality – Claims:
Quality – Registry:
Advancing Care Information:
The Advancing Care Information (ACI) performance category replaces the Medicare EHR Incentive Program or Meaningful Use. The primary difference between Meaningful Use and ACI is the scoring. For more information on performance scoring and requirements click on the document link.
Specification for the possible measures are listed below.
MIPS ACI Transitional Measure_Electronic Prescribing
MIPS ACI Transitional Measure_Health Information Exchange
MIPS ACI Transitional Measure_Medication Reconciliation
MIPS ACI Transitional Measure_Patient Electronic Access_Patient Access
MIPS ACI Transitional Measure_Patient Electronic Access_View Download Transmit (VDT)
MIPS ACI Transitional Measure_Patient Specific Education
MIPS ACI Transitional Measure_Protect Patient Health Information_Security Risk Analysis
MIPS ACI Transitional Measure_Public Health Reporting_Immunization Registry Reporting
MIPS ACI Transitional Measure_Public Health Reporting_Specialized Registry Reporting
MIPS ACI Transitional Measure_Public Health Reporting_Syndromic Surveillance Reporting
MIPS ACI Transitional Measure_Secure Messaging
The new category in 2017, improvement activities focuses on improving outcomes in care coordination, patient engagement and patient safety. The IA category is the third and final category impacting the overall MIPS performance scoring of 15%. There are 92 Improvement Activities available for providers to choose measures that align most closely with their practice’s patient base.Each improvement activity is weighed as “Medium” for 10 points or “High” for 20 points.
Specifications for possible High-weighted activities:
Click the link for more information regarding CMS Transforming Clinical Practice Initiative: https://innovation.cms.gov/initiatives/Transforming-Clinical-Practices/
Specifications for possible medium-weighted activities:
Resources for Additional Information: