PQRS, VBM and Meaningful Use End, MIPS Begins

2016 Alliance sponsor article provided courtesy of MSOC Health

Medicare’s Quality Programs get a reboot starting in 2017 with the introduction of the Merit-Based Payment System or MIPS. This program revises and combines the current PQRS, Value-Based Modifier and Meaningful Use program into a single program with Medicare payments impacted starting in 2019. The MIPS program is part of the MACRA legislation passed in 2015, providing a major overhaul to how physicians are paid by implementing a true Pay for Performance model.

Here’s what you need to know about this major change to Medicare Payment:

What’s the bottom line?

If you fail to meet MIPS requirements in 2017, you’ll have a 4% reduction from the standard Medicare payment rates in 2019. Note that this is significantly less than the potential 7-9% cut in 2018 payments if you don’t participate in the three programs this year. However, the penalty increases over the coming years, back to 9% in 2022 and beyond.

You could receive an increase over the standard payment rate in 2019. The amount will vary based on your MIPS score. If you achieve a score of 70 or higher, you’ll also receive a share of $500 Million with all other providers achieving this threshold. The higher your score, the more your payment rate in 2019 will increase.

Who is eligible?

  • Physicians, PAs, NPs, CRNAs and Clinical Nurse Specialists

Who is excluded?

  • Providers who are excluded receive the standard Medicare Payment in 2019:
  • Low Volume: Medicare Payments < $30,000/year OR Medicare Patients < 100/year
  • First Year: Provider is in their first year billing to Medicare under any TIN
  • Qualifying Participant in an Advanced Alternative Payment Model*

What do I need to do to avoid a 2019 payment cut?

Very little, but 2017 is a transition year designed to allow practices time to adjust to the new requirements. Failing to take MIPS requirements seriously and ramp up your efforts in 2017 will make it virtually impossible to be successful in future years when penalties increase. For the 2017 reporting year, avoid 2019 penalties by doing at least one of the following:

  • Report 1 quality measure to CMS for a 90 day period
  • Report 1 clinical practice improvement activity completed during a 90 day period
  • Report on 4 specific activities from the Modified Stage 2 Meaningful Use measures, but with no threshold to achieve

What do I need to do to get 70 points and share in the $500 Million?

A composite score is calculated based on data reported for a period of at least 90 consecutive days during Calendar Year 2017. There are many paths to a score of 70. To learn more, request a copy of MSOC Health’s MIPS 2017 Scoring Outline by contacting us at info@msochealth.com.

Where do I start?

First, learn everything you can about MIPS and its requirements, both for the transition year of 2017 and also for 2018 and beyond. Bookmark CMS’s Quality Payment Program website. Second, evaluate your efforts and results under the current programs as they form the basis for MIPS. Third, make a detailed plan for both 2017 and 2018. And finally, educate your physicians and staff about Value-Based care and the changes needed for your practice to succeed under the new Pay for Performance Model.

What else do I need to know?

If you belong to a Medicare Alternative Payment Model (Shared Savings Program, NextGen or Pioneer ACO, Oncology Care Model, Comprehensive ESRD, Bundled Payment Models), or are a non-patient facing specialist (radiology, anesthesiology, pathology) there are special rules that apply to you.

Feeling Overwhelmed?

MSOC Health is here to help. Our nationally recognized expert, Jeanne Chamberlin, is leading a team of MSOC senior staff focused on MIPS. Our MIPS Consulting Package provides a comprehensive approach to guide practices through the maze of changing government regulations and deadlines. Contact Jeanne at 919-442-2422 or j.chamberlin@msochealth.com

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