While the new quality payment program through MIPS is somewhat similar to the current MU and PQRS, it introduces new complexities, according to our own Debra Harris who recently hosted the most comprehensive MACRA and MIPS webinar to date. Jam-packed with measure and scoring examples, the webinar gave attendees a solid understanding of how to achieve points for both ACI and quality measures of MIPS categories in the proposed MACRA rule. Read on to get a (somewhat) quick recap.
The weighting for MIPS categories for the 2017 performance year includes 50% for quality and 25% for Advancing Care Information (ACI). Given the imminent nature of the proposed changes, these categories should be taken seriously as MIPS scoring determines MIPS payment adjustments.
MU is now ACI, and under the proposed rule for Medicare participants only. You have the option to use either a 2014 or a 2015 Certified EHR Technology for 2017, and a 2015 CEHRT is required for 2018 and subsequent years.
- Protection of Patient Health Information (security risk analysis);
- Electronic Prescribing;
- Patient Electronic Access (patient portal/education);
- Coordination of Care Patient Engagement);
- Health Information Exchange (Clinical Information Reconciliation; and
- Public Health Registry Reporting (Immunization).
ACI scoring accounts for 25 of the 100 points of the MIPS composite score, or 25%. Three components are used: base score (50 points toward the score, based on 6 objectives and their measures); performance score (measures patient electronic access, coordination of care through patient engagement, and health information exchange objectives); plus the bonus point (registry reporting). You can earn up to 131 points, but it’s reaching 100 points that allows you to receive the full 25 for ACI performance. While the breakdown is complex, Harris’ explanation makes the process seem less daunting than when the proposed rule first came out.
Quality reporting and scoring
Quality represents 50 percent of your MIPS performance score with an emphasis on outcome measurement. As we discussed in our last webinar, flexibility is certainly built in as your facility may choose which measures to report and be evaluated on. Clinicians will report one crosscutting and one outcome measure (if there is no outcome measure then another high priority measure), plus your four individual or specialty set measures for a total of six. There are more than 300 measures to choose from. In the appendix of the proposed rule (pages 773 – 945) are the proposed quality measures; included are Tables defining the different measure groups such as the Individual, Cross-cutting, Specialty sets, proposed new measures and suggested revisions.
Finally, Harris assures attendees that understanding the scoring of quality is even more fun than that of ACI. LOL! (We felt this post needed one more acronym.) The measures are decile points from 1-10; CMS publishes decile based on national performance in a baseline period (two years prior to the performance period). Performance is compared and points are assigned based on which decile range the performance data is located, all receiving at least one point depending on the comparison percentage figure. You’ll want to listen to the webinar for specific examples and learn more about maximums, topping out, and performance periods. Scoring also allows up to 10 percent “extra credit” total in bonus points for additional high priority measures.
This tutorial is packed with information vital to the MACRA transition, especially considering how significantly the ACI and quality categories are weighted. In addition to staying on top of frequent changes in health IT standards, find a champion in your practice on reporting. Know the deadlines and how 2017 reporting is impacted. Stay informed. Come back to the blog and sign up for more webinars. The proposed rule isn’t final, but let’s prepare to the best of our ability with the knowledge we have now.