MIPS explained: 4 categories physicians must master

Reimbursement under Medicare is about to evolve yet again. While the rules are still being finalized, providers should be getting ready for their unveiling this fall.

The Centers for Medicare & Medicaid Services (CMS) recently announced its proposed rule for the Merit-based Incentive Payment System (MIPS), which will measure physician performance in four categories-resource use/cost, quality, advancing care information and clinical practice improvement activities-with bonuses or penalties that could eventually reach up to 9% of physicians’ Medicare reimbursements.

 

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While the bonuses or penalties don’t start until 2019, physicians and practices must begin reporting their results in January, notes Robert Doherty, senior vice president, governmental affairs and public policy at the American College of Physicians (ACP). “There’s talk that it’s two years down the road,” he says, referring to the 2019 date. But it’s not if CMS start collecting data in 2017.

The first three categories essentially replace and consolidate parts of existing performance measurement systems, combining parts of the Value-based Payment Modifier, the Physician Quality Reporting System (PQRS) and the electronic health record (EHR) incentive program (Meaningful Use).

The fourth category-which will measure a practice’s performance in areas like care coordination, beneficiary engagement and patient safety-marks a new front in Medicare’s attempts to rate doctors and practices.

 

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Here’s how physicians can start preparing now to get their best scores in the four categories:

1/ Quality

The quality measure, which will hold the most weight at the outset (50%), provides physicians with a menu of 200 sub-measures from which they must choose six that best accommodate their practice or specialty.  One of those measures needs to be an outcome measure, and one needs to be “cross-cutting,” meaning that it’s applicable to all specialties.

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