CMS has restructured and combined several payment programs into the MIPS program. A rough translation of the 2016 vs. 2017 programs is
- Quality replaces PQRS, the PQRS reporting portion of Value-based Modifier, and the CQM section of Meaningful Use.
- Advancing Care replaces the remainder of Meaningful Use.
- Cost replaces the claims cost portion of Value-based Modifier.
- Improvement Activities is a new type of payment incentive, not a replacement for a 2016 program.
Quality represents 60% the score. Clinigence will continue to provide EHR/DSV, registry, and GPRO Web Interface reporting services for this category. Clinigence supports both individual and GPRO (group) reporting. Clinigence does the data submission to CMS for this category.
- If more than 6 measures are reported for the Quality portion of MIPS, CMS will take the 6 that scored the highest to calculate the total Quality score out of a possible 60 points. (Reference Final Rule: https://www.federalregister.gov/documents/2016/11/04/2016-25240/medicare-program-merit-based-incentive-payment-system-mips-and-alternative-payment-model-apm)
Advancing Care represents 25% of your score. You must continue to work with your EHR vendor on this category. CMS provides an attestation as well as EHR submission option for this category. Your EMR vendor will provide information on what measures and submission methods they will support.
Cost has a score of zero for 2017. Utilization is calculated by CMS based on the claims they receive. There is no action required by you or your vendor(s).
Improvement Activities represent 15% of the score. This is a new score and provides lots of options. Clinigence supports the requirements that are supported by CQMs and potentially some of those that are care-coordination oriented. Clinigence will work with you to help you determine what is right for you. CMS is providing both an attestation and vendor attestation submission option for this section. Your EMR vendor may support the vendor attestation submission mechanism. If not, the providers should perform their own attestation similar to the way they have traditionally attested to MU.
- It is important to note that these activities are not about reporting scores, they are about the practice/provider actively using the tools available to achieve the activity goal for at least 90 days. In other-words if you select Depression Screening as one of your activities, Clinigence will set up a measure to help you achieve the activity goals but the practice/provider must use the measure to achieve the activity goal of "Diabetes screening for people with schizophrenia or bipolar disease who are using antipsychotic medication."
For more information, vist CMS.gov: