From the November 2016 issue of HealthCare Business News magazine

Clinical practice improvement activities.
Accounting for 15 percent of the MIPS score, activities in this category aim to improve care coordination, beneficiary engagement and overall patient safety. There are more than 90 options CMS has listed for physicians to choose from, but weight will be given to public health initiatives, as well as home participation. Health care professionals who are more lab-based and not as patient-facing will only need to report one activity in this category.

Cost of care. The cost category accounts for 10 percent of the total score, and MIPS calculates this value based on the total cost of care, including tests and other treatments billed to Medicare. This means there are no reporting requirements for this category. Therefore, providing reasonable costs of treatment is beneficial to health care providers, since the costs will be compared to industry benchmarks.
What impact will MIPS have on physicians?
To reiterate, MIPS scores will be used to calculate positive — or negative — payment adjustments of up to 5 percent, which means MIPS will have a real impact on the bottom line. However, the value of the adjustment will be based on participation, and CMS has provided four separate options for physicians to consider.
• Test the quality.
Physicians can submit some data, and payments will not be subject to an adjustment, which is ideal for practices with limited experience reporting quality data.
• Participate as required for part of the calendar year.
Under this option, physicians must submit all required data for less than a full calendar year. Positive payment adjustments are available for this level of participation.
• Participate as required for the full calendar year.
Another path to a positive payment adjustment is by submitting all required data for the entire calendar year. This is an attractive option for practices with significant quality reporting experience.
• Participate in an advanced APM.
For practices that have substantial payment exposure to a Medicare Alternate Payment Model, qualified participants that meet Advanced APM criteria receive a 5 percent payment bonus.

How can physicians prepare?
The short answer is to track each aspect of your practice as much as possible. CMS has various measurements in each category, and physicians can select which best align with each health care specialty. The MIPS program is point-based so providers will have to accumulate credits, or points, to receive a positive score. To ensure a health care organization is prepared before the evaluation period begins, follow these five tips:

November 2016 Magazine

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