SUPPLEMENT

Making Sense of MACRA: Options for Meeting the 2018 MIPS Requirements

 

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To avoid a negative payment adjustment in 2020, practices must achieve a MIPS final score of at least 15 points for the 2018 performance period. This supplement outlines possible options for small and large practices.

Fam Pract Manag. 2018 Nov-Dec;25(6):17-20.

The Medicare Access and CHIP Reauthorization Act (MACRA) established the Quality Payment Program (QPP) to shift Medicare payment from volume to value by creating two payment tracks. Most family physicians will initially participate in the Merit-based Incentive Payment System (MIPS) track, which assesses practices on their performance in four categories:

1. Quality,

2. Cost,

3. Improvement activities,

4. Promoting interoperability.

To avoid a negative payment adjustment in 2020, practices must achieve a MIPS final score of at least 15 points for the 2018 performance period. Practices can meet this performance threshold in a variety of ways.

This supplement outlines possible options for small and large practices to meet the 2018 QPP reporting requirements for the MIPS track.

COMPLEX PATIENT BONUS

Any practice that submits data in at least one MIPS performance category can earn up to five bonus points for caring for complex patients. This bonus is added to the MIPS final score. The Centers for Medicare & Medicaid Services (CMS) calculates the amount of the bonus using a practice’s average hierarchical condition category (HCC) risk scores and the proportion of dual-eligible patients (i.e., patients who have both Medicare and Medicaid) in the practice. Since the amount of this bonus will vary by practice, it is not included in the scenarios in this supplement.

PROVISIONS FOR SMALL PRACTICES

CMS has included the following QPP provisions designed to assist small practices (15 or fewer eligible clinicians [ECs]) in MIPS:

• Small practices will have a five-point bonus automatically added to their final score.

• Improvement activities will be double-weighted for small practices. Small practices only need to attest to either one high-weighted activity or two medium-weighted activities to satisfy requirements for the improvement activities performance category.

• Small practices will receive three points for quality measures they submit that do not meet data completeness

 
 

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