MIPS 2018 –Improvement Activities & Cost

Brett M. Paepke, ODDirector, ECP Services

Objectives• Review of MIPS Scoring System• Discuss the Improvement Activities performance category• Introduce the Cost performance category• Discuss changes for 2018

MIPS Fundamentals for 2018

• Eliminates the separate penalties of MU, PQRS, and VBM

• Rolls certain components of each program into a composite/final score for MIPS• 0-100 based on performance in 4 categories

• Your Final Score is compared to the “performance threshold” to determine how you’ll be paid for Part B services in 2020• +/- 5%

Improvement Activities

Improvement Activities

• Activities that are likely to result in improved outcomes• More than 100 available for 2018• Each activity carries a “weight”• High weight = 20 points• Medium weight = 10 points

• Goal: 40 points for full credit• Small practices (≤ 15 clinicians) have point values doubled• Only need to complete 1 “high” weighted or 2 “medium” weighted activities

for full credit

Improvement Activities• Examples of activities• Provide 24/7 access to eligible clinicians or groups who have real-time access

to the patient’s medical record

• Implementation of use of specialist reports back to referring clinician or group to close the referral loop

• TCPI participation

• Provide educational opportunities for new clinicians

Bonus Point Opportunity• CMS aims to reward clinicians who use functions of CEHRT to

accomplish an improvement activity• 10 points in the Advancing Care Information category• Many activities available to provide this bonus• Some are High weighted, some Medium weighted• 10 bonus points awarded regardless of weighting

• 24/7 Access + Secure Messaging?• Do you provide a way for patients to get care after hours?• Does the doctor caring for the patient after hours have real-time access to the

medical record?

Improvement Activities

• What’s new in 2018?• Minimum “any 90 consecutive day” performance period for an activity• Points continue to be doubled for small practice clinicians• More activities to choose from• More activities offering CEHRT bonus• A few activities from 2017 have had their weightings changed

• If you participated in 2017, be sure to check qpp.cms.gov or the final rule to see if your plans need to change for 2018 based on weighting

Cost

Cost

• Wasn’t proposed to enter MIPS until 2019 performance period• Carryover of concepts from the Value-based Payment Modifier• Two measures are created and analyzed:• Medicare spending per beneficiary• Total per capita costs for all attributed beneficiaries

Cost• No data submission required of you. Both measures are calculated by

CMS based on regular claims information.

• If Cost score not possible, points will be reallocated to Quality performance category

• Provide the care you deem appropriate for your patients each and every day, no more and no less, and your costs ”are what they are”

MIPScellaneous• Performance Periods:

• Improvement Activities: at least 90 consecutive days• Cost: full calendar year

• Some Improvement Activities have had weightings change for 2018• More activities offering CEHRT bonus• Yes/No attestation for Improvement Activities prior to March 31, 2019• Can report as a group or individual

• Decision to report as a group requires you to report as a group for the other two performance categories as well

• Only 1 clinician in group needs to satisfy activity for entire group to benefit