What is MIPS?

What’s going on with MACRA? What is MIPS? How can you avoid losing up to 9% of your practice’s revenue to government penalties? Is there a way for small and medium-sized practices to succeed under new legislation from the Centers for Medicare and Medicaid Services (CMS)?

If you’ve been asking yourself these questions (and more) about the future of healthcare and your practice, you’re definitely not alone.

A recent survey conducted by Advisory Board revealed some very interesting statistics about independent medical practices, MACRA, and the coming changes in value-based healthcare programs. For example, 70% of medical providers who responded to this survey reported that they were anywhere from “concerned” to “totally freaked out” about MACRA (the Medicare Access and CHIP Reauthorization Act of 2015).

Advisory Board also points out that in the proposed rule for MACRA, CMS (the Centers for Medicare and Medicaid Services) predicted that solo practices and small practices were more likely to be negatively impacted, thanks to the complexity of the Act’s reporting requirements. And 67% of respondents to another survey, conducted by Black Book Market Research, cited MACRA as cause to merge with a larger practice and/or cease independent operation.

MACRA Isn’t as Scary as You Might Think

All that sounds pretty dire, right? Well, there’s actually a lot of good news. First, the proposed rule was very complicated and would have made it very difficult for independent practices to comply. Fortunately, though, the final ruling has made things a lot simpler, especially for small and rural practices.

So it’s simpler and easier to comply – great! But that still doesn’t answer your questions, does it? So, what can you expect from this kinder, gentler MACRA final rule? What is MIPS? And how will you participate to avoid penalties?

Two Ways to Participate – But Most Practices Fall Under MIPS

Basically, practices have two options for participating in MACRA. They can either report through MIPS, or through an Advanced APM (Alternative Payment Model). While CMS would really love it if every practice in the US chose the latter, the fact is – most practices aren’t quite ready. MIPS provides an easier way to avoid negative adjustments and gain some positive incentives, even if you aren’t ready to start reporting right away in 2017 (as long as you start reporting by October 2).

With an estimated 70% of practices falling under MIPS, you might think that more providers would be up-to-date on exactly what they’ll need to do, how to report, and what MIPS will mean for their practices, right? Well, as of early December 2016, only 50% of MIPS practices reported that they would be ready to start reporting on January 1, 2017. In fact, a lot of providers are still asking, “What is MIPS?”

What does MIPS stand for?

MIPS stands for the Merit-based Incentive Payment System under MACRA. This payment track is basically a consolidation of three earlier programs:

  • PQRS (Physician Quality Reporting System)
  • Value-Based Payment Modifier
  • Meaningful Use

Instead of all-or-nothing scoring that would’ve automatically meant penalties for a lot of practices, in the final ruling, practices participating through MIPS this year will need to report for at least 90 days (so you’ll have to start reporting by October 2), and their scores will be based on four categories:

  • Quality
  • Cost/Resource Use
  • ACI (Advancing Care Information)
  • CPIA (Clinical Practice Improvement Activities)

This year, you’ll really only have to report on 5 chosen measures, and your Cost/Resource Use score won’t actually count as a percentage of your overall MIPS score yet, either. In fact, you can avoid a negative penalty just by reporting on a single measure for 90 days. The idea here is that practices should have enough time to come onboard with MACRA that they won’t have to give up their independence to stay afloat. See? We told you there was good news!

Forr more information on these scoring categories and some solutions to help make reporting even easier, contact us to see how Oculus Health can help your clinic.