Diving into the ocean before checking the depth can leave you unprepared in treacherous waters. Clinicians with a small practice may find navigating the complexities of quality reporting programs, such as the Merit-based Incentive Payment System (MIPS), challenging and overwhelming. However, having a detailed plan in place can prove successful for eligible clinicians.

The MIPS Reality: Adapt and Engage                                                                           

MIPS is part of a two-track physician payment system emphasizing value-based payment models that conform to the Centers for Medicare and Medicaid Services (CMS) mission to provide better care for individuals and better health for populations at lower cost. Created after the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), MIPS permanently repealed the flawed sustainable growth rate (SGR). To determine a clinician’s overall MIPS score, three different categories are used (with a fourth to be added in 2019), each with their own scoring system.

Keep the Fundamentals in Mind

Navigating the MIPS landscape effectively requires a solid understanding of the fundamentals. While many providers are not required to report to MIPS (the CMS site can help determine your practice requirements), those who do will find three components to their MIPS score:

  • Practice Improvement: There are more than 80 options to choose from, so take time to look through the list. In this category, clinicians are acknowledged for their focus on care coordination, patient engagement and patient safety. It’s likely you have already adopted one or more of these measures, but I strongly recommend keeping copies of evidence, like screenshots or reports, to prove that these are taking place during your 90-day reporting window. Make sure the provider’s name and the date are visible on the screen shot or printout.
  • Advancing Care Information (ACI): Formerly known as “Meaningful Use Measures,” ACI is a bit more complex. This section requires you to fulfill five required measures for a minimum of 90 days. These can range from a security risk analysis to patient-specific education to clinical data registry reporting. You can earn bonus points for reporting up to an additional nine measures for a minimum of 90 days.
  • Quality: This component offers the most options. You’ll report measures that are the best fit for your practice — for example, cardiac rehabilitation or breast cancer screening. Outcomes must be among your six measures. If outcomes do not apply to your practice, then you must select a high priority measure. Learn more about the procedures you plan to report and document in your EHR.

You may submit just one ACI and one Quality measure to avoid any penalty. Working with your EHR vendor is your best option. Work with your staff to incorporate this documentation into your practice workflow. Look for any tools available from your EHR vendor or Registry to help select your best reporting options – for example, group vs. individual, or eCQM vs. registry measures. Ideally, this tool will show you the range of options throughout the year, calculating your actual MIPS score in various ways and enabling you to focus on the measures that will maximize your score. You can also view the specialty measures sets posted on the Quality Payment Program (QPP) website.

It’s important to find a reliable source of information on MIPS. The American Academy of Family Physicians (AAFP) “MACRA Ready” program is one such option, accessible and applicable even for non-members, at http://www.aafp.org/practice-management/payment/medicare-payment/mips.html.

Preparing for 2018:  5 ways to boost your MIPS score next year

To improve your score and surpass the savviest MIPS user, consider the following:

  • For 2018, if you are not already on a certified EHR, plan to get on one. Look for one that is or will be “2015 certified”, that is, “MU-3” certified; it needs to be installed and running live by 10/1/18 at the latest. This will still allow for the required 90 days of reporting on MIPS in 2018
  • Make sure to have your workflows for proper documentation in your EHR set and begin reporting the Quality Measures
  • Check your performance throughout the year and compare to any available benchmarks. A performance check every month is advisable. Being diligent allows a provider to flag any issues early
  • Try to improve your score as the year progresses with better documentation and EHR usage
  • Look for which ACI and/or Quality components provide you with the biggest possible score improvement with minimal practice disruption and effort

MIPS may seem complicated, but it doesn’t need to be. Maintaining a high MIPS score not only earns you a payment adjustment but also shows that you provided high-quality patient care supported by EHRs.