Ahoy Meaningful Users! We have survived the turbulent CMS waters of the EHR Incentive Programs and PQRS pirates and have reached the shore with a few life preservers (Modified Stage 2 for one) in hand!
All nautical jokes aside, give yourself a HUGE pat on the back for holding yourself together and hanging in (yes I know at times you thought about running). As CMS sends MU toward the sunset, we need to look through their telescope at what lies ahead.
Modified Stage 2 MU measures will continue to be reported through 2017 (you will be given the option to report proposed Stage 3 measures at this time as well, if you dare). In 2019 the MACRA (Medicare Access and CHIP Reauthorization Act) signed into law April 15, 2015, will streamline MU and other quality measure reporting models into the proposed MIPS (Merit Based Incentive Payment System) and/or APMs (Advanced Payment Model) reporting to determine Medicare reimbursement or penalties.
MIPS will assess providers using a combination of scores in Quality (based on PQRS), MU (based on the EHR Incentive Program), use of resources with the VBM (Value-based Modifier) and Clinical Practice Improvement Activities (CPIA), a new measure designed to award credits to healthcare providers who demonstrate a “deliberate effort to improve clinical measures and/or participate in APMs”.
CMS is proposing that each year the MIPS performance threshold will be set using the median or average of all recorded MIPS scores from the previous years as follows:
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Components of MIPS Score |
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MIPS 0-100 points |
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MU 25% |
PQRS
30% |
VBM/costs
30% |
CPIA
15% |
CMS will begin measuring data for MIPS in 2017…. So PLEASE, keep on reporting your PQRS and MU data! If MU is achieved in 2017 the proposed rule will give you an automatic 25 points for payment year 2019. If PQRS is reported in 2017 you could have an additional 30 points added to your MIPS for the 2019 payment year! That’s like free money (almost).
Besides payment incentives and adjustments, all MIPS -eligible providers will have publicly displayed scores. Yes! You read that correctly! The Physician Compare website will make each category of scores available for individual providers along with range comparisons across the country.
MACRA also proposes to reward those providers/practices who participate in APMs, with an additional financial incentive of 5% of their Medicare reimbursements received in the year preceding the MIPS payment year, via a lump sum. APMs include ACO and PCMH participants (we just happen to have Julie on- board our ship to advise here), as well as any of the other Medicare Shared Savings Programs (MSSPs) and/or federally mandated Health Care Quality Demonstration programs.
The big question being raised now is, “what about the money?”.
By: Kim Bandura