As the Merit-based Incentive Payment System (MIPS) wrapped up its first year, it achieved 91% participation of eligible providers. With so many participating, interest is high in what was successful and what can be improved. MIPS is part of the Quality Payment Program (QPP), established by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), and is a quality payment incentive program for physicians and other eligible clinicians, which rewards value and outcomes in one of two ways: through MIPS and Advanced Alternative Payment Models (APMs), which we’ve discussed in previous blogs: MIPS and APM
Centers for Medicare & Medicaid Services (CMS) administrator Seema Verma said they are looking for ways to ease the reporting demands on physicians. “Even with this high rate of participation, we are committed to removing more of the regulatory burdens that get in the way of doctors and other clinicians spending time with their patients,” she writes.
In a May 2018 article on their website, she also noted that participation rates for accountable care organizations and clinicians in rural practices were higher than the national average, at 98% and 94%. “What makes these numbers most exciting is the concerted efforts by clinicians, professional associations and many others to ensure high-quality care and improved outcomes for patients,” Verma wrote.
After reviewing the 2017 MIPS requirements and results, CMS developed policies for 2018 that continue to achieve their overall objectives of reducing burden, adding flexibility, and helping clinicians spend less time on unnecessary requirements and more time with patients.
Specifically, for 2018 they have:
- Reduced the number of clinicians that are required to participate by giving them more time with their patients, not computers
- Added new bonus points for clinicians who are in small practices, treat complex patients, or use 2015 Edition Certified Electronic Health Record Technology (CEHRT) exclusively as a means of promoting the interoperability of health information
- Increased the opportunity for clinicians to earn a positive payment adjustment
- Continued offering free technical assistance to clinicians in the program
The technical assistance offered has proven extremely successful. In 2017, they received a 99.8 percent customer satisfaction rating by over 200,000 clinicians and practice managers. The technical assistance networks also responded to 98.7 percent of initial referrals for additional support from the Quality Payment Program Service Center and Centers for Medicare & Medicaid Services (CMS) Regional Offices within 1-business day. They aim to respond quickly so clinicians can spend less time trying to figure out the program and more time with their patients.
The “Patients Over Paperwork” Initiative, recently launched by CMS, is another new tool being added to the MIPS arsenal. It is a cross-cutting, collaborative process that evaluates and streamlines regulations with a goal to reduce unnecessary burden, increase efficiencies, and improve the beneficiary experience. This effort emphasizes a commitment to removing regulatory obstacles that get in the way of providers spending time with patients.
CMS also noted in their recent article that the Bipartisan Budget Act of 2018 gives them additional authority for “gradual implementation of certain requirements for three more years to further reduce burden in areas of MIPS.” In April, major physician groups sent a letter to CMS that seeks a shorter MIPS reporting period in 2018. The letter, led by the American Medical Association (AMA), asked that the reporting period be reduced from a full calendar year to a minimum of 90 consecutive days.
In their letter, the AMA and cosigners declared that “While we acknowledge that certain reporting options, such as reporting certain outcome-based measures, may require a lengthier reporting period than 90 days to ensure statistical validity, we believe there is a substantial opportunity to reduce the cost and labor involved in reporting MIPS data.” Among the cosigners are the American Academy of Family Physicians and about 50 other medical groups.
While CMS has made improvements for 2018, and the AMA with others are seeking additional improvements, there are things all MIPS participants can do right now to help maximize the program. Beth Houck, VP of Customer Experience for SA Ignite, makes the following suggestions to get the most return for your participation in the program. Among her suggestions are:
- Use your high scores to negotiate better contracts or compete for a position in exclusive or narrow networks – MIPS includes hundreds of quality measures that are essential to effective care for patients and as a result, span programs. Using these measures as benchmarks, you can demonstrate improvement and success. Fact-based quality performance data can then be used to justify more lucrative contracts with commercial payers
- Attract and retain the best and brightest clinicians and partnerships – A higher MIPS score will make you a more attractive partner and reinforces the value of your practice in an acquisition. You can differentiate your practice by demonstrating leadership in the movement to value-based care. You can also show that you have the infrastructure in place that allows clinicians to succeed in complex compliance programs as a group or as individual contributors
- Motivate clinicians with organizational goals and peer comparisons – If you align your MIPS measures to the goals of your practice or with other high-profile value-based payment programs, you can motivate clinicians towards achieving a common set of goals. Aligning goals and measuring across programs offers a way to illustrate the success
As participants leverage the MIPS metrics to strengthen their relationships with other providers, their patients will also reap the benefits of receiving better quality and better priced care. Driving down costs while improving efficiency are at the heart of MIPS and the other Quality Payment Program initiatives. Moving forward in the program’s second year, CMS has made improvements and modifications designed to increase further the already successful launch of MIPS. The future is bright indeed for providers and patients alike who value increased efficiency at more affordable prices.