One of these things is not like the other.
If you look at the four performance categories under the Merit-based Incentive Payment System (MIPS), you may notice that, from a reporting standpoint, three of the areas feel familiar, while one does not. That’s because three MIPS categories - care quality, advancing care information, and cost - are reminiscent of past Medicare reporting and payment programs, while the fourth category, improvement activities, is new.
The quality category was designed to replace the Physician Quality Reporting System (PQRS). Advancing care information (ACI) is a replacement for the Meaningful Use program. Cost is meant to replace the Value-Based Modifier (VBM). Healthcare providers that are eligible to participate in MIPS and want to earn a positive payment adjustment have a lot to learn. And because the improvement activities category is new, it is an area of MIPS that deserves extra attention.
Here are five key points that clinicians and their teams need to understand about the improvement activities portion of MIPS.
1 - During the first year of MIPS (2017) the categories will be assigned the following weights:
- Quality - 60 percent
- Advancing Care Information - 25 percent
- Improvement Activities - 15 percent
These weights will be adjusted in 2018 when cost (which is not being reported in 2017) is introduced into the mix.
2 - The improvement activities category is designed to reward clinicians for their efforts to deliver care with a focus on care coordination, beneficiary engagement and patient safety.
3 - To comply with the requirements for this category, most participants will need to report four activities. Two of those activities must be selected from a set of activities with a “high” weight, and two activities must be chosen from a group of activities that have been assigned a “medium” weight.
4 - Smaller practices and those in rural or health professional shortage areas can report fewer activities. Participants in these groups can choose to report one “high” level activity or two “medium” level activities.
5 - A list and description of 92 possible reporting activities can be found here on the Quality Payment Program website. Those activities are categorized into the following groups:
- Achieving Health Equity
- Behavioral and Mental Health
- Beneficiary Engagement
- Care Coordination
- Emergency Response and Preparedness
- Expanded Practice Access
- Patient Safety and Practice Assessment
- Population Management
Quality improvement activities, like care coordination, will become increasingly important as healthcare becomes driven even more by value-based payments. Not only are improvement activities a cornerstone of high-quality, patient-centered care, but they are evolving into measures of performance that will significantly affect reimbursements.
MIPS incentives will grow over the next few years from a max potential of an additional 4 percent for 2017 to an additional 9 percent in 2019 and beyond. Healthcare providers should be looking to the future and considering how they can put themselves in a position to be successful in the areas in which they will be held accountable.