This post was updated based on the Quality Payment Program final rule on October 24, 2016.
The Centers for Medicare and Medicaid Services (CMS) recently released the much-anticipated final rule that offers details on how CMS will implement many of the key quality- and payment-related provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
With the start of the program around the corner on January 1, 2017, it is important for healthcare providers and provider organizations to start the process of analyzing the requirements they face under MACRA now.
The Merit-Based Incentive Payment System (MIPS) is part of the new Quality Payment Program under MACRA and combines requirements previously included in three separate programs administered by CMS: the Physician Quality Reporting System (PQRS), the Medicare EHR Incentive Program, and the Value-Based Payment Modifier. MIPS implementation includes calculating a Composite Performance Score for all participating clinicians that represents performance in four categories, each with their own requirements and weighted values (applicable to the 2017 performance year).
CMS has estimated that between 592,000 and 642,000 eligible clinicians will be required to participate in MIPS in 2017. With the first performance period set to begin on January 1, 2017, there is no time like the present to begin learning about the requirements and preparing for success.
Medicare providers who have previously participated in the Physician Quality Reporting System (PQRS) will see some similarities in the MIPS Quality Performance category, worth 60% of the MIPS Composite Performance Score in 2017. In response to one of the biggest criticisms from providers about the PQRS program, CMS is proposing to allow individual MIPS eligible clinicians and groups the flexibility to determine the most meaningful measures and reporting mechanisms for their practice when reporting for the Quality Performance category.
A summary of the key requirements and characteristics of the MIPS Quality Performance category are below:
CMS has heeded the call to streamline its various quality and payment programs and ease certain requirements—for example, by reducing the number of reported quality measures from 9 under PQRS to 6 under MIPS and by eliminating the cross-cutting measure requirement in 2017.
Even so, given the short timeline for preparation and many commercial plans implementing similar programs, it’s more important than ever to prepare your organization to manage the requirements. Stay up to date on future posts analyzing the requirements of MIPS and MACRA by signing up for our newsletter.
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