MIPS Streamlines Quality Reporting Categories

The Medicare Incentive Payment System (MIPS) consolidates current Medicare quality programs (Physician Quality Reporting System, EHR Meaningful Use, and Value-Based Payment Modifier) and adds a new category for Improvement Activities. MIPS also offers the first substantial rewards for achieving high-quality care.

MIPS reporting begins in January 2017, with payment adjustments starting in January 2019. Each “eligible clinician” or group will receive a “composite performance score” for performance in four categories—Quality, Cost, use of certified electronic health records under Advancing Care Information (ACI), and Improvement Activities—compared against the average of all MIPS clinicians. Those scoring above average receive a bonus, while those scoring below average receive a penalty. Scoring is somewhat flexible, but here are some general guidelines:

• Quality counts 30 percent (60 percent in 2019 and 50 percent in 2020), based largely on the Physician Quality Reporting System (PQRS).

• Cost counts 30 percent (0 percent in 2019 and 10 percent in 2020), replacing the Value-Based Payment Modifier. The Centers for Medicare and Medicaid Services will calculate this, with no reporting required.

• ACI, which assesses the use of electronic health records and replaces the Meaningful Use program, counts 25 percent.

• Improvement Activities, the new category, counts 15 percent.

MIPS bonuses—and penalties—will be up to 4 percent in 2019, 5 percent in 2020, 7 percent in 2021, and 9 percent in 2022. Those payment adjustments are budget neutral. But there is an extra $500 million a year for bonuses of up to 10 percent for “exceptional” performers, from 2019 to 2024.■