Maybe there was no other way to do it. Reign in the high cost of healthcare by boiling it all down to one easy to digest number. Rate each eligible Medicare Part B clinician on a 0 – 100 score. Take all the complexities of four categories (Meaningful Use, Cost, Improvement Activities, Quality Reporting) mix them thoroughly and shove them in the oven until golden brown. Out comes a Composite Score for every Medicare Part B clinician in the MIPS program. Repeat once a year. Base reimbursement on the score and take money from the low scorers and give it to the high scorers. Make the scores public. Unintended consequences? You bet, but we will have to wait to see what they are.
The Final Rule defines the composite score by stating: “Final score means a composite assessment (using a scoring scale of 0 to 100) for each MIPS eligible clinician for a performance period determined using the methodology for assessing the total performance of a MIPS eligible clinician according to performance standards for applicable measures and activities for each performance category.” By definition there will be low scoring providers because they have to balance high scorers as the neutral reimbursement score floats from year to year in this zero sum program.
An entire wave of consultants is gearing up to assist affected providers with the necessary steps and strategies to score higher on the scale. I should know, I am one of them. The fact that money has been set aside in the Final Rule to assist small practices and those that struggle to improve their score is proof that the competitive advantage will be going to large and high volume Medicare practices in this new world of competition. Make no mistake about it, there will be winners and losers, and we are on the cusp of a reimbursement world based on what appears to not be a level playing field. Larger and wealthier practices will have the compliance and regulatory staff to gain an advantage from Day 1. This is not your Daddy’s Meaningful Use program.There is a high possibility this group will be receiving money that comes from the smaller and more rural practices. What will this mean in the long run? We simply don’t know as this is an experiment that has the potential for unpredictable outcomes and unintended collateral damage.
The CMS EHR Incentive programs were adjusted and tweaked on a regular basis to bring sanity to the process by modifications, exemptions and exclusions. I hope this will be the case in the MIPS program. The risk that a subset of the provider community could be damaged is very real unless critical oversight leads to prompt program adjustments. There is too much at stake to do otherwise.
The tale of 90 days of MIPS reporting has been told and retold many times, and like it is with most tales, it has many versions. Unlike most tales, where you can enjoy any version of your liking, the key facts in this tale have long-term implications for healthcare providers and organizations, both in terms of money and reputation. So, please read carefully.
Did it cross your mind that what would be the point of doing all the work getting ready for MIPS when CMS is offering “Pick Your Pace Options”? If it did, you are not alone. But, do you understand how much incentive money you would be giving up by using the One Patient, One Measure option?
The last 90 continuous day performance period to report on MIPS, October 2, 2017, is just around the corner. If you haven’t already started with preparation for MIPS, the 2016 Quality and Resource Use Reports (QRUR), which were released yesterday, can serve as a good starting point. Let’s take a look at how you can leverage the 2015 and 2016 QRURs to jump-start your MIPS readiness
The tale of Goldilocks and her penchant for finding things that are “Just Right” strikes a perfect chord with MIPS. On one hand Physician Organizations, healthcare thought leaders, and CMS are trying....
One definition of "hacking" is to “modify in a skillful or clever way”. So, let’s take a look at MIPS and examine one potential hack that falls into the “skillful or clever” category.
Are you wondering if MIPS score of 100 is achievable? Well it is with some strategic planning and knowing where to focus on. Read on to find out how.
Recently Medicare Part-B providers got their much awaited MIPS eligibility status letters from CMS. If you got MIPS exempt status as individuals (NPI level), pay close attention
Decision of determining the winning combination of submission method and quality measures is a tough one. All the selected measures would have to go in one submission method basket, and when you have to put all your eggs in one basket, you got to pick that basket very carefully.
How is that even possible? The Registry submission method, which includes Qualified registries as well as Qualified Clinical Data Registries (QCDRs), has more Quality measures available for reporting than all the other submission methods. But don’t dismiss the possibility yet.
In this time of transition, STOP. Take a closer look. MIPS is unlike any other incentive program you have participated in before. Every point translates into dollars. Don’t leave money on the table.