An Update on MIPS Readiness

If you read this newsletter and JUCM, you know the Merit-based Incentive Payment Systems (MIPS) offers a few options in an attempt to encourage participation and allow providers, essentially, to customize their participation to suit their practice. That includes when they start participating, within some limits. And if you read any news sources at all, you know there are more than a few wrinkles in the rollout. With that in mind, here are a few highlights that may be most applicable to the urgent care clinician and operators:

• Both 90-day and full-year submissions will be assessed for submission completeness and scored accordingly.
• MIPS eligible clinicians/groups can participate in the new Quality Payment Program one of three ways in 2017:
  • Test: Submit a minimum amount of 2017 data (at least one quality measure or one improvement activity) to avoid a downward adjustment to Medicare Part B payments in 2019.
  • Partial: Submit 90 days of 2017 data to Medicare and you may earn a neutral or small positive payment adjustment in 2019.
  • Full: Submit a full year of 2017 data to Medicare and you may earn a moderate positive payment adjustment in 2019.
• Eligible clinicians who decide to report 90 days or a full year of data must meet submission requirements to earn a positive payment adjustment of any kind.
• Between now and 2020, practices that receive Medicare Part B payments will see a combination of incentives and penalties based on their participation and All MIPS participants will get an inflationary adjustment of 0.5% per year for the first 3 years (valued at a total of 1.5% by 2019). Participants in MIPS will receive a bonus or penalty that ranges from -4% to +4% this year, and escalates to between -9% and +9% in 2020.
• Partial- and full-year participants must report on six quality measures and meet data completeness of at least 50% (note: not 100%, at least not now) for each measure or specialty measure set. There are 271 quality measures to choose from, overall.
• Overuse of certain tests and medication regimens could result in additional penalties.

The Centers for Medicare and Medicaid Services offers an overview of the whole program on its website.