Healthmonix Advisor

MIPS As An On-Ramp to Value-Based Care

Posted by Lauren Patrick on December 16, 2021

As you report your MIPS data, it can feel like a lot of work with little ROI for the last two years. But wait. Sometimes we need to step back and evaluate the bigger picture. While we often focus on "getting the job done", there are changes in the healthcare economy that are occurring that are strategic.

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Topics: MACRA & MIPS, APMs, VBC, Value-Based Care

Why You'll Be in For a MIPS Shock - No More Bonus Points or Loopholes

Posted by Lauren Patrick on December 6, 2021

On November 2, 2021, the Centers for Medicare & Medicaid Services (CMS) released the 2022 Physician Fee Schedule (PFS) Final Rule which governs MIPS and other quality payment programs. Anticipated changes were made to MIPS, making the program more challenging in 2022 and signaling additional changes to the program in coming years.

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Topics: MACRA & MIPS, Quality Performance Category, IA Performance Category, Cost Performance Category, PI Performance Category, MIPS Value Pathways, 2022 PFS Final Rule

New Challenges Brought on by Changes to MIPS Threshold & Performance Categories

Posted by Lauren Patrick on September 24, 2021

With the release of the 2020 feedback report detailing the 2.2% maximum possible payment adjustment and the release of the 2022 Proposed Rule, MIPS participants find themselves wrestling with lingering disappointment from participation in the program in previous years, and resistance to the idea that MIPS will be financially rewarding and challenging, in terms of reporting requirements, in 2021 and beyond.    

This is the second in a series of blog posts on the 2020 payment adjustment and the 2022 Proposed Rule, that will address this sense of disappointment and show how the future of MIPS will contain much more rigorous program requirements and create greater financial rewards.  To see financial and program success, you will need to be prepared to meet the new challenges.  We have the guidance you need to succeed in 2021 and beyond.    

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Topics: MACRA & MIPS, Quality Performance Category, Cost Performance Category, 2022 PFS Proposed Rule

MIPS Disappointed, But It All Changes in 2021

Posted by Lauren Patrick on August 26, 2021

With the release of the 2020 feedback report detailing the 2.2% maximum possible payment adjustment and the release of the 2022 Proposed Rule, MIPS participants find themselves wrestling with lingering disappointment from participation in the program in previous years, and resistance to the idea that MIPS will be financially rewarding and challenging, in terms of reporting requirements, in 2021 and beyond.   

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Topics: MACRA & MIPS, COVID-19, 2022 PFS Proposed Rule

MIPS - How Many Options Do I Have?

Posted by Lauren Patrick on March 10, 2021

As we move into 2021 and beyond, we see CMS putting some real teeth into the Merit-based Incentive Payment System (MIPS) program.  This is the first year where we see more than two percent incentives possible.  Exemptions and exclusions are narrowing.  Participants in other value-based programs are being forced into MIPS reporting because of higher thresholds for exclusion and elimination of other reporting options.

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Topics: MACRA & MIPS, MIPS Value Pathways, APM Performance Pathway

MVPs - Will they replace 'traditional' MIPS?

Posted by Lauren Patrick on January 28, 2021

There has been much talk around MVPs in the CMS quality reporting arena. MVP means MIPS Value Pathway, and it’s a reporting framework that CMS is communicating as (a) the next evolution of MIPS and (b) a transition tool for getting to other alternative payment modules. As CMS continues to define and refine their vision of the MVPs, they have started to call the current framework 'traditional MIPS' to prepare for the inclusion of the MVP option. You’ll see this when you visit the QPP site. That said, how can MVPs affect MIPS?

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Topics: MACRA & MIPS, CMS, 2021 PFS Proposed Rule, MIPS Value Pathways

MIPS 2021 Incentives and Penalties | How Can You Prepare?

Posted by Lauren Patrick on January 14, 2021

For years, we’ve heard that the Merit-based Incentive Payment System (MIPS) will provide a noticeable incentive for participants in this Medicare FFS program. And for years, there have been reasons why that has not occurred. First, CMS wanted to ‘start slow’ with the MIPS program in 2017 and 2018, so the caps on penalties and incentives were small. Then the potential penalties and incentives were raised, but the threshold for qualifying for an incentive remained low. This, coupled with the program’s budget neutrality meant there was not much revenue to distribute to high performers. Then COVID-19 negated much of the program for the last two years. So here we are, in year five, and we see that the program, for the first time, will have a significant downside and upside potential.

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Topics: MACRA & MIPS, CMS, APMs, Cost Performance Category, 2021 PFS Final Rule

The 2021 Final Rule: New Programs, Higher Standards and COVID-19

Posted by Seretha Curry on December 16, 2020

 

The long-awaited CY 2021 Medicare Physician Fee Schedule Final Rule update is now here. Despite the disruptions of the Public Health Emergency COVID-19, participation in performance year 2019 was strong. Thus the 2021 Final Rule moved forward with finalizing a number of proposed changes, including a higher performance threshold for performance year 2021, anticipated changes in weight to the Quality and Cost performance categories of the Merit-based Incentive Payment System (MIPS), and the introduction of the APM Performance Pathway. Other expected initiatives, such as MIPS Value Pathways, the requirement for registries to build their own benchmarks for certain measures, and the sunsetting of the CMS Web Interface, have been pushed back to at least the 2022 performance year.

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Topics: MACRA & MIPS, APMs, COVID-19, 2021 PFS Proposed Rule, APM Performance Pathway

Will 2021 MIPS Finally Bring Significant Financial ROI for Providers?

Posted by Matthew Major on November 24, 2020

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.

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Topics: MACRA & MIPS, Policy

What to Do in the Last 90 Days of MIPS 2020

Posted by Phillip Spence on September 30, 2020

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.

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Topics: PRO Tips, MACRA & MIPS, Quality Performance Category, IA Performance Category, Cost Performance Category, PI Performance Category