MIPS Mastery, Chapter 7

MIPS Mastery is a seven-part series on optimizing performance under the Merit-Based Incentive Payment System, originally produced by PYA.

Will Any of This Information Be Made Publicly Available? 

CMS is advancing its plan to make information publicly available with MIPS. Quality and meaningful use data slowly has been made available on the Physician Compare website. Under MIPS, CMS has proposed new plans to make similar information publicly available. CMS will begin publishing Clinicians’ performance on each of the four MIPS categories, as well as their overall CPS. CMS also will make available the national threshold CPS to give the public context for individual provider performance. There also are plans for users to view and download more detailed performance data from CMS’ publicly available datasets.

How to Master MIPS

Given that MIPS brings fundamental changes to the Medicare physician payment system to incentivize quality and efficiency, healthcare professionals should anticipate investing significant time and effort into fully understanding the new rules. And, with that understanding, providers and provider organizations can begin making strategic decisions regarding measure selection, performance improvement activities, internal tracking, and reporting mechanisms to protect and maximize future reimbursement.

What should providers be doing right now to prepare for MIPS?

  1. The first step in preparing for MIPS is getting current programs “under control.” While MIPS replaces current Medicare fee-for-value programs – PQRS, VM, and MU – their themes/concepts very much remain intact. Groups and individuals that can succeed with existing programs will find that MIPS is an extension of current programs. Those who have yet to engage current CMS programs can use the rest of 2016 as a “test lap” before MIPS goes into effect in 2017.
  2. Just like the VM Program, accurate risk capture for providers’ patient population is crucial. The resource use category of MIPS (and many other CMS programs) depends heavily on accurate risk capture. The end of 2016 would be an excellent time for a coding and documentation review to ensure patient risk capture is accurate.
  3. Pay attention to the final rule, which is scheduled to be released late this year. While we do not expect major changes to MIPS in the final rule, CMS likely will finetune several provisions based on public comments. When the rule is finalized at the end of the year, it would be much better to re-paint the side of the house rather than build the entire thing from scratch. In other words, start preparing now, and make adjustments later as necessary!

Read Chapter 6

Martie Ross, Principal with PYA Consulting