Medicare is pushing practitioners to shift from a fee-for-service to a value-based payment system that rewards keeping patients healthy and imposes financial penalties for poor performance. While accountable care organizations have been at the forefront of the quality care program called QPP, most practices will be affected by rules finalized in November.
The launch of the merit-based incentive payment system, or MIPS, allows practitioners to ease into the transition and still be rewarded. Their 2019 payments will be adjusted based on their 2017 performance. Only new Medicare providers, and practices with less than 100 patients or that generate less than $30,000 in annual billings, are excluded from evaluation.
While avoiding a MIPS penalty of 4 percent is relatively easy, 2017 is the best time to test the performance waters and prepare for a rapid push in healthcare reform. So, how does a practice secure the biggest payout under MIPS without overwhelming staff members?
Practices should work on activities that earn the most points and best prepare them for higher incentives or advanced payment model participation. MIPS works on a 100-point system that’s organized into three domains for 2017:
· 60 percent from meeting quality measure thresholds
· 25 percent from Advancing Care Information, which replaces meaningful-use measures
· 15 percent from clinical improvement activities, some of which earn bonus points when completed
The final rules vary from what was originally proposed, such as the elimination of the cost performance category. For details, visit https://goo.gl/twQhpl
from Medicare and http://bit.ly/2hCtnKt
from the AMA.
Medicare’s timeline drives the numbers. In 2017, a practice with minimal involvement in MIPS will avoid the 4 percent reduction in payments imposed for nonparticipation. With 90 days of data, the entity can earn a small positive payment adjustment; a full year of data guarantees a chance at the greatest amount of payment.
Medicare will review the data during 2018 and provide feedback to the practice. In 2019, the payment adjustment goes into effect.