2018 MIPS Performance Feedback – QPP Portal and Targeted Reviews
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) replaced the Medicare Sustainable Growth Rate (SGR), which was how CMS previously controlled the cost of Medicare Payments to physicians. MACRA is aimed at strengthening Medicare access, improving physician payments, and encouraging better patient care among other improvements. Under MACRA, CMS is required to implement a Quality Payment Program (QPP), which offers clinicians and practices two separate tracks: (1) the Merit-Based Incentive Payment System (MIPS) track; and, (2) the Advanced Alternative Payment Model (Advanced APM) track. Both tracks can result in penalties for not meeting certain requirements/benchmarks or incentives for meeting and exceeding requirements/benchmarks.
The 2018 final MIPS scoring, and performance data has been released, so what do you and your executives need to know?
The Quality Payment Program (QPP) Portal
After almost a decade of poor information availability from CMS, they have finally provided a website that is easy to use and full of information that practices need to excel in a value- and performance-based quality system. Unfortunately, clinicians and practices have often failed to explore this wealth of information.
Is it possible that CMS could get the MIPS scoring wrong? There were several examples of this from the first year of MIPS and there will be more examples from 2018. Prior to the completion of the targeted review window after the 2017 performance year, CMS realized that their calculations pertaining to the following aspects of MIPS, had been inaccurate: (1) Application of the 2017 Advancing Care Information (now Promoting Interoperability) and Extreme/Uncontrollable Circumstances hardship exceptions; (2) Awarding of IA credit for successful participation in the IA Burden Reduction Study; and (3) Addition of the All-Cause Readmission (ACR) measure to the MIPS final score. From those 3 pieces, CMS had to recalculate the final payment adjustment rate for all MIPS eligible clinicians. Additionally, through the targeted review process, CMS discovered other scoring blunders, including: not applying the low-volume threshold exclusion to clinicians who were not, in fact, MIPS eligible due to volume; improper assessment of group reporters; and wrongly scoring groups that had opted out of various MIPS APM programs, among others.
The good news is that the targeted review process worked. It provided MIPS eligible clinicians and practices the opportunity to have CMS take a second look at the data after it had been scored. CMS corrected their errors and hopefully learned from them.
The message here is that CMS doesn’t always get it right, so make sure to log into the QPP portal, review your 2018 performance feedback and submit a targeted review, if you have concerns about the accuracy of the scoring.
The criteria which determine MIPS eligibility are multi-faceted and complex. ReportingMD understands these criteria’s and works with client organizations to optimize incentive performance in the MIPS (and other value-based care programs.)
With the proven experience of our client services team and Total Outcomes Management (TOM™) a powerful measure calculation engine, ReportingMD can help you navigate the complexities of the MIPS program.
We were invited by CMS to help develop the MIPS program, which provides our team with unique expertise and a depth of experience that’s unmatched.
Using TOM™, practices can gain operational visibility to the quality performance of their physicians and avoid CMS penalties for non-compliance. TOM™ aggregates data from multiple sources to identify and manage patient care gaps.
Learn why mid to large sized healthcare organizations turn to ReportingMD for powerful tools that help improve patient care, improve quality outcomes, and maximize reimbursements.