It’s ALIVVVEE! Here’s What You Need to Know about MIPS.

This is the first in a series of articles about MIPS. Stay tuned to this blog for additional information about MIPS and Eyefinity product updates.

Since CMS released the final rule on October 14, MIPS has been a popular topic on news sites, blogs, and Facebook posts.

So, what do you need to know about MIPS and how does it affect your practice? Read on to get the scoop.

What’s MIPS?

MIPS (Merit-based Incentive Program System) is a Medicare payment program that is intended to incentivize eligible clinicians (ECs) to focus on the quality of care rather than quantity of care.

In a nutshell, MIPS streamlines and combines meaningful use and PQRS. MIPS does not apply to hospitals; it applies to individual clinicians.

Clinicians will be scored based on the following areas in 2017:

Category Explanation Value
Quality Formerly PQRS and CQMs 60%
Advancing Care Information Formerly meaningful use 25%
Clinical Practice Improvement Expanding hours improving outreach, etc. 15%

The lion’s share, 75%, is accomplished using a certified EHR—completing measures and quality reporting currently associated with meaningful use and PQRS. Data collection begins in 2017.

A fourth category, Cost, will be added in 2018. Cost will be based on episode-specific costs as reported on claims.

What’s at stake?

Payment adjustments start at 4% in 2019 and ramp up quickly to 9% in 2022. Since MIPS is required to be revenue neutral, the program applies a penalty to the bottom performing ECs to pay incentives to the top performing. Given that payment adjustment can be up to 9% in 2022, ECs can expect to see an 18-point spread in Medicare payments. That means serious money to some ECs.

Payment Year 2019 2020 2021 2022 and beyond
Max Adjustment 4% 5% 7% 9%

MIPS is designed to make ECs compete in quality performance. Since MIPS takes money from lower performing ECs and pays it to higher performing ECs, there’s a lot of incentive for ECs to bring their A-game.

Keep your eye on this blog for more MIPS information.

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Masoud Nafey, OD

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