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CMS Update – MIPS: New regulations you can’t ignore

November 23, 2016
Business Affairs
From the November 2016 issue of HealthCare Business News magazine

By Mark Johnson

Since 2009, physicians have struggled to understand the constantly evolving compliance standards and regulations of the Meaningful Use program. Now, the recently announced Merit-Based Incentive Payment System (MIPS), formed as a result of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), will provide a new set of regulations to measure the quality of care delivered by health care professionals in all settings, including hospitals, private practices and specialty medical centers. The Centers for Medicare and Medicaid Services (CMS) has measured patient care through a patchwork of programs, including the Physician Quality Reporting System, the Value Modifier Program and the Medicare Electronic Health Record (EHR) Incentive Program.

However, beginning in 2017, these programs will be streamlined into MIPS. The goal of MIPS is to improve the relevancy of Medicare’s value-based and quality- based payments, while increasing health care providers’ flexibility to choose measures and activities appropriate to the type of care they provide. MIPS allows physicians to receive reimbursements based on measurements in four performance categories: quality; advancing care information; clinical practice improvement activities; and cost.



The MIPS score evaluates overall care, and therefore, physicians are no longer limited to reporting care to only Medicare beneficiaries. Instead, CMS will begin scoring health care providers for all patients served during 2017. Each provider’s MIPS score will be used to generate a positive, negative or neutral adjustment to their Medicare Part B payments.

In the first year of reimbursements, which will begin in 2019, adjustments will be calculated so positive and negative adjustments can be up to 5 percent. These new reporting requirements and measurements will also affect hospitals and health systems to ensure their physicians remain compliant.

What will MIPS measure?
Quality of care. All aspects of the quality of care will be evaluated, which will account for 50 percent of the MIPS score. Readmissions, the number of tests and consultations, as well as patient experience and length of stay, will play an important role in the score of the quality of care delivered. For example, radiologists could be measured on the documentation of radiation dose exposure, participation in a radiation dose index registry and the number of follow-up visits needed for each patient.

Advancing care information. This category is the new Meaningful Use facet of the MIPS plan. Accounting for 25 percent of the total score, health care organizations will now be required to use certified Electronic Health Record (EHR) technology. Providers have options on how to report the use of the technology based on how physicians use the system in their practice. There will be an emphasis on interoperability and information exchange so health care systems can work together to provide better overall care.

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