Much like medical practices and the healthcare sector in general, the Merit-Based Incentive Payment System involves many working parts. In order to provide patients with care that’s more in line with value than process, Quality Measures (QM) help quantify the patient-centered care experience. These QM datasets, once collected, are then submitted to the Center for Medicare and Medicaid Services, whose evaluation determines how much practices are reimbursed under the MIPS program.
Even though MIPS is in its third year, you may be confused about QMs and how to ensure that your practice is set up for success. Here are a few key considerations to be mindful of in the reporting and data-gathering process:
1. Determine for certain if you’re MIPS eligible
Obviously, only doctors with Medicare patients are MIPS eligible, but just because you accept these patients doesn’t by definition mean you’re subject to its mandates. In light of this, make sure that you are eligible. There’s a greater chance you are this year than last as physical therapists, qualified audiologists, clinical psychologists and registered dietitians (as well as nutritional professionals) are all eligible in 2019 but weren’t in 2018.
2. Understand what QMs are reportable and usable
There are literally hundreds of QMs to choose from under the MIPS program and each fall into one of six buckets or categories: Efficiency, Intermediate Outcome, Outcome, Patient Engagement Experience, Process and Structure. Which QMs you choose – and how much data must be delivered – is contingent upon the types of health services you provide. Assuming you score well, selecting one from each bucket demonstrates to CMS that your patients receive a more well-rounded experience. If you do choose one bucket more than another, ensure that at least one QM is from the outcome category. Visit CMS’ website for a comprehensive compilation of the 2019 QMs.
3. Know how long the reporting period should last
How much data you collect largely depends on the measure type, but what’s uniform for everyone is the performance period. Whichever QMs you select, ensure that they’re representative of care performed over a full 12 months. Anything short of that may make you ineligible or result in point reduction. Additionally, submitting five or fewer QMs may decrease your final score by 10 points.
4. Reporting window for 2018 is still open
Even though we’re a quarter of the way into 2019, you can still submit 2018 QM data to CMS if you haven’t yet. But you’ll want to get a move on, because the deadline is April 2 at 8 p.m. Eastern.
“45% of your final MIPS score derives from QMs.”
5. Be cognizant of QM scoring changes
Of course QMs don’t represent the entirety of the MIPS program and how much you’re reimbursed, depending on your score. But it accounts for a solid chunk. Indeed, 45 percent of your final score derives from QMs. However, it’s not as heavily weighted as it was in 2018, when it accounted for 50 percent of the final tally.
6. Bonus points are possible
Who doesn’t like extra credit? No one, so CMS is making it possible to receive bonus points. They can be obtained pretty easily, too, depending on your reporting method. For example, since end-to-end electronic reporting reduces paper and expedites processing, CMS is encouraging this submission channel by providing bonus points to practices who leverage and make full use of electronic health records. Additionally, since better outcomes are the ultimate goal of MIPS, submitting two or more outcome QMs may also yield added bonus points.
There are many layers to MIPS reporting, and it will certainly take awhile for practices and clinicians to get a better feel for how the program operates. After all, MIPS is only in its third year and MIPS reporting guidelines remain in flux. Tangible Solutions has the tools and industry experience you need to improve workflows and deliver on value-based care. Contact us for MIPS reporting done right.
