Clinicians participating in the Merit-Based Incentive Payment System (MIPS) are set to finally receive a worthwhile financial return for 2021 reporting. Providers have been unsure whether incentive returns of less than 2% justifies shifting focus to achieve a high score in the program. A provider collecting $400,000 in Medicare Part B payments in 2020 will only receive $6,700 for scoring well in 2018 quality payment program (QPP) performance. While this does produce a positive return on investment, it may cause practices to question whether it is worth the effort required to track and report measures.
The last 90 days of the year. Many might be ready to say goodbye to 2020 as a year filled with challenges, adjustments and ever-shifting expectations in our personal and professional lives. For those clinicians who are eligible for participation in the Merit-Based Incentive Payment System (MIPS), the last 90 days of the year also represents the beginning of some measurement periods and the final opportunity to improve in others.
The 2021 Proposed Rule was released last week, and there are some potential changes that you should keep your eye on. Scouring through the entire release, it’s apparent that the Centers for Medicare & Medicaid Services (CMS) kept to their two main objectives:
- Minimize changes to reduce the burden on providers digging out of COVID-19
- Keep the momentum of the Quality Payment program moving forward
The quick answer is NO!
There has been quite a bit of discussion, and some press, about the reporting period for MIPS for 2020. I have seen a few articles saying that no data reflecting services provided January 1, 2020 through June 30, 2020 will be used in the Center for Medicare & Medicaid Services (CMS’s) calculations for the Medicare quality reporting and value-based purchasing programs. However, if you read the Quality Payment Program – COVID-19 Response, Updated 6/24/2020, there is no mention of an all-inclusive change to the reporting period.
In the last couple of weeks, some major changes have been made to the immediate future of Value-Based Care payment models.
Some of these updates include:
- The extension of the Oncology Care Model (OCM) until June of 2022. The Centers for Medicare & Medicaid Services (CMS) is also giving practices the ability to abdicate downside and upside risk performance during the COVID-19 outbreak.
- The delay of starting the new Direct Contracting model to April 1st, 2021.
- The extension of the Next-Gen ACO model until December 2021.
- The option for participating entities in the Bundled Payments for Care Improvement Advanced (BPCI) payment model to eliminate upside or downside risk.
- The removal of COVID-19 episodes of care for certain Medicare ACO models.
Quality and Cost are two fundamental focus areas in the Volume to Value-Based Care transition. The Centers for Medicare & Medicaid Services (CMS), seeks to incentivize higher quality care at a lower cost through programs like MIPS. In recent years, the primary focus of MIPS has been Quality reporting, however Quality and Cost will be equally weighted in 2022. Mandated increases and lack of insight into current MIPS scores make it a top priority for practices to learn how Cost impacts their revenue.
We know the current regulatory updates for the Quality Payment Program (QPP) program. To date, the Centers for Medicare & Medicaid Services (CMS) has issued many changes. The 2019 MIPS reporting requirement had an extended deadline and options for hardship exemptions. The 2020 MSSP program reporting period had many changes in both of the interim final rule with comment periods (IFCs) issued by CMS, at the end of March and the end of April. CMS has also added a COVID-19 improvement activity to the 2020 program, that provides full credit for the Improvement Activity category for MIPS, if an individual or 50% of a group (TIN) participates in clinical trial reporting. No changes to the reporting window or other parameters of the program have been issued.
The Centers for Medicare & Medicaid (CMS) is working rapidly to update policies and allow healthcare providers to flexibly apply best practices in response to the COVID-19 pandemic. Programs such as Hospitals without Walls and the existing Patients over Paperwork have been deployed. Removal of barriers have resulted in exponential growth of telehealth and remote patient monitoring. Advanced payments to healthcare providers are being provided to counter the effects of changing patterns of healthcare use, reduction in elective procedure, increase in ICU utilization and other ongoing unanticipated changes.
There is a tsunami of information coming at us all about COVID-19, the impact to healthcare practices, the business climate, and the federal government response. On Friday, we saw monumental legislative changes. I haven't read the entire 887 page document yet, but here are a couple of the best recaps I've seen.