Question

The quality category of MIPS is decreasing in 2018 to 30% from the previous 50% where
the cost category is rising from 10% to 30%. What are the implications of this for
organizations? Will quality be affected?

If providers are hospital based, are they exempt from MIPS? Why?

Answer 1

Answer :

MIPS is currently CMS largest value based care payment program and is designed to be a major catalyst towards transforming the health care industry from fee For service to pay For value .

Note that MIPS does hot impact the medicaid nor eligible hospital promoting interoperability programs .as a results ,some clinicians may be subject to both MIPS and medicaid promoting interoperability program. This is but one example of a clinicians being subject to multiple value care programs ,either from a single payer or across multiple payers.

The financial and reputational impacts stemming from the MIPS score are irrevocably attached to a clinician ,even if the clinician changes organisation .

If a clinician earns a MIPS score For 2018 and moves to another organisation in 2019 ,the new organisation will inherit the MIPS payment adjustment applied in 2020 based on the 2018 score earned by the clinician at the previous organisation .

This fact impact how organisations should credential and contract with clinicians and may impact an organisation ability to attract the best and brightest if group scores are hot competitive .

The medicare payment prior to MACRA was For service payment system ,where clinicians are paid based on volume of services ,not value .the merit based incentive payment system is one of the two payment tracks created under MARCA.

They will hot exempt from MIPS .these providers will need to participate in the medicaid EHR incentive program as well as all three categories in MIPS (quality , advancing care information , improving activities ).

Exemptions :

Providees newly enrolled in medicare For first time during the performance period.

Providers participating an advanced alternative payment model as a qualiqualifying APM participant.

Providers who fall below the low volume threshold ,seeing 200 or fewer medicare part B patients a year or having less than or equal to $90,000 in allowed medicare part B charges in a year.