Healthmonix Advisor

10 PRO Tips for Conquering the Quality Performance Category of MIPS (Part 2)

Posted by Lauren Patrick on September 15, 2016

Last week, we introduced some of the core concepts of the MIPS Quality Performance Category. This week, we are going to elaborate on these premises with Part 2 of our "10 PRO tips for Conquering the Quality Performance Category of MIPS."

yellowalert.pngALERT: This post was published before the release of the MACRA final rule on 10/14/2016. Please view our MIPS website for up to date regulations.


6Outperform your peers and earn more 

Based upon 2016’s Value-Based Payment data, we should be looking for rather large payment increases for high performance under the MIPS program. This year there were very few high performers (128 groups to be exact) but a significant number of non-reporters (over 5,000 groups). That means that the money CMS collected in penalties from the non-reporters went to a small cohort of high-performers, driving bonuses to upward of 15%. That bonus potential gets pretty steep in 2022 at 27%. However, we believe that payment increases will not be this steep. By 2022, more providers will have invested in quality reporting. Fewer non-reporting providers means less penalty money to distribute among high performers.



Pay attention to the CMS Calculated Measures

CMS will add in two or three measures to your Quality Category Performance Score.  These will be calculated from the claims data you submit to CMS.  The CMS-calculated measures include scores for Acute Conditions Composite, Chronic Conditions Composite and All-Cause Hospital Readmissions. The Acute Conditions Composite measure is derived from claims data related to hospital admissions for bacterial pneumonia, urinary tract infections and dehydration. The Chronic Conditions Composite measure is composed of data related to diabetes, chronic obstructive pulmonary disease or asthma, and heart failure. 



Select an outcome measure and a cross-cutting measure in which you can achieve a high score

The proposed rule for MIPS emphasizes the value of reporting on outcome measures. In 2017 providers will be required to report one outcome or other high-priority measure if no outcome measure is applicable.  Each eligible provider or GPRO needs to include one crosscutting measure and one outcome measure. But again, just reporting is not enough.  Your performance on each measure, as compared to your peers, matters.  A low quality score will do you little good in reporting.



Think about the ‘bonus points’ – extra credit for your Quality Score

Unlike PQRS, there are bonus points to be earned.  You can achieve bonus points for reporting extra outcome, high-priority, and patient experience of care measures.  In addition, you an achieve up to a 5% bonus for reporting your measures using certified EHR technology (CEHRT).



Get started early

Even with the new options for partial reporting for 2017 that were just announced by Andy Slavitt, to maximize your revenue, you must report for the entirety of 2017 to achieve the full incentive potential.  Becoming proficient at quality reporting under PQRS in 2016 will facilitate a smoother transition to reporting under MIPS. 

Topics: PRO Tips, PQRS, MACRA & MIPS, Quality Performance Category