When it comes to the Quality Payment Program (QPP) and moving Medicare Part B clinicians to a performance-based payment system, most practices know by now that there are 2 tracks to choose from—Advanced Alternative Payment Models (APMs) or the Merit-Based Incentive Payment System (MIPS). For 2017, MIPS has 4 performance categories, weighted as follows:
This blog post will focus on MIPS and the improvement activities performance category.
Let’s review the basics of who can participate in the QPP. To qualify for the QPP you must bill more than $30,000 to Medicare Part B and provide care for more than 100 Medicare patients per year. If you decide to participate in MIPS, you may earn a performance-based payment adjustment.
For MIPS you must also be a:
- Physician assistant
- Nurse practitioner
- Clinical nurse specialist
- Certified registered nurse anesthetist
You cannot participate in MIPS if:
- You are newly enrolled in Medicare (2017 is your first year participating)
- You are below the low-volume threshold
- You participate in an advanced APM
You can choose to report as an individual or group. If you choose to report as a group, that means there are more than 2 clinicians whose individual NPIs have reassigned their billing rights to a single Tax Identification Number. Your data get aggregated and sent as the group.
The first performance period began January 1, 2017 and closes December 31, 2017. To potentially earn a positive payment adjustment under MIPS, you must send in data about the care you provided and how your practice used technology in 2017 to CMS by March 31, 2018 for a payment adjustment in 2019. If you have not yet gotten started, it’s time to pick your pace.
The improvement activities performance category of MIPS is new for 2017 (meaning it doesn’t replace an old reporting system), and comprises 15% of the MIPS score. This category assesses how much you participate in activities that improve clinical practice. Examples include ongoing care coordination, clinician and patient shared decision making, and expanding practice access. This performance category also includes incentives that help drive participation in certified patient-centered medical homes (PCMH) and alternative payment models (APMs).
Most participants will have the flexibility to attest that they have completed 4 out of 93 improvement activities under 9 subcategories for a minimum of 90 days. These 9 subcategories include:
- Expanded practice access
- Population management
- Care coordination
- Beneficiary engagement
- Patient safety and practice assessment
- Participation in an APM
- Achieving health equity
- Integrating behavioral and mental health
- Emergency preparedness and response
You can choose to attest to the set of activities that are most meaningful to your practice since there are no subcategory reporting requirements.
Improvement activities can either be medium-weighted (for 10 points of the total category score), or high-weighted (for 20 points of the total category score). The maximum number of points that clinicians can earn in the improvement activities category is 40.
To get the maximum score of 40 points for the improvement activity score, you may select any of these combinations:
- 2 high-weighted activities
- 1 high-weighted and 2 medium-weighted activities
- Up to 4 medium-weighted activities
Clinicians who practice in a PCMH, or similar specialty practice, automatically receive full credit for the category.
If you are not participating in an APM, a PCMH, or comparable specialty practice, and you do not select any activities, you will receive zero points in this performance category.
To calculate the score for the improvement activities category, add the total number of points earned for completed activities, and divide by the total maximum number of points (40). That number is then multiplied by 100 to achieve the total score.
Are you ready? We are!
Care360 EHR is fully certified for the QPP based on 2014 Edition Certification and the associated CMS regulatory requirements. The QPP requires EHRs to advance to the 2015 Edition Certification by January 2018, and Care360 will be ready for that deadline. The Care360 EHR solution is prepared to support your practice with MIPS in 2017 and beyond. Read our MACRA brochure to learn more.
For more information on how the Care360 EHR can help you report, call 1.888.491.7900, or read our white paper, “3 things to know about making the EHR switch.”