Healthmonix Advisor

With the first performance year of the Merit-based Incentive Payment System (MIPS) drawing to a close, you may have just started getting accustomed to how MIPS reporting works. Although the 2018 MACRA final rule introduced changes to how MIPS performance data should be captured for the upcoming performance year, it may be a relief to hear that largely the changes just build upon the existing 2017 regulations.

Over the last two weeks, we've shown you how to select quality measures. Now that you've decided which measures to collect data for, it's time to start reporting! If you have reported PQRS in the past, the process will be similar with a few major changes. Eligible clinicians who are new to reporting may want to first check out our article on the basics of quality measures prior to understanding how to completely report a quality measure.

In our last post, we covered some of the basic questions you should be asking yourself when choosing quality measures to report under MIPS. In part two of this series, we go over a few more specific questions that can help guide you to picking the best measures for your practice.

So you’re a MIPS-eligible clinician (if you’re not sure about your participation status, check out our post about how to find out), and you don’t want your practice to miss out on the reimbursement you know you deserve. But how should you decide which quality measures to actually report to CMS? How can you know if the measures you’re choosing will ultimately lead to reporting success, and is there a way to use those measures to not just fulfill the requirements but actually improve your practice? We’ve put together a two-part post to guide you through the most important factors to consider when deciding what might be best for you and your practice. First, the basics:

The shift from volume to value-based care can be frustrating, especially when the reasons behind such a significant change aren’t clear. But with an estimated 250,000 American deaths per year caused by medical errors, minimizing these errors is a noble and vital effort. Additionally, CMS is now raising the bar for healthcare providers with the assessment of quality metrics against benchmarks and peers. With that in mind, let’s break down the meaning of, and intentions behind, Quality Measures.

The Quality Performance Category

The Quality Performance Category is one of four Performance Categories to be reported for the Merit-Based Incentive Payment System (MIPS). Carrying the highest weight of the four Performance Categories, the Quality Score will determine 60% of the MIPS Composite Performance Score for eligible clinicians or groups.

The MIPS Quality Performance Category is replacing PQRS reporting in 2017, folding it into the Merit-Based Incentive Payment System. The Quality portion will comprise 60% of an eligible clinician's MIPS Composite Performance Score for 2017.  To calculate that score, there is significant math involved.  This article will walk you though the calculations and logic used to determine your Quality score, but it is important to note that many data submission vendors will automatically give you a predictive calculation.

Today, the Department of Health and Human Services (HHS) released the final rule with comment period for the Quality Payment Program under MACRA. Consistent with what was discussed in the proposed rule, the MACRA Quality Payment Program will have two tracks: (1) Advanced Alternative Payment Models (APMs) and the Merit-Based Incentive Payment System (MIPS). 

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."

Under the forthcoming Medicare Access and CHIP Reauthorization Act (MACRA), the Physician Quality Reporting System (PQRS) is being absorbed into the Merit-Based Incentive Payment System (MIPS). Specifically, PQRS will transition into one of the four Performance Categorys of MIPS, the Quality Performance Category.