MIPS: All Is Not As It Appears

The MACRA/MIPS program is complex enough without having to decide what is real and what is not. I recently wrote a post entitled “Fake News – MIPS Style” and in the past week I have come across additional examples of misleading information that only serves to muddy the waters. Sometimes it is not what is said, but what is omitted that can be the problem. Here are a few items to be aware of in your quest to achieve a high MIPS score.

When it comes to MIPS information, it is not what is said, but what is omitted that can be the problem. Proceed with caution in your quest to maximize your MIPS score.

MACRA (or MIPS) Certified Technology 

There is no such thing. Sure, we have Certified Electronic Health Record Technology (CEHRT) but that has existed for years under the EHR Meaningful Use program. Some may think this is a clever marketing strategy but at best this is a spin. Don’t be fooled. When a vendor touts MACRA Certified EHR, proceed with caution. There is simply no such animal as MIPS or MACRA certified technology.

Selection of CQMs

The proper selection and submission method of Clinical Quality Measures is one of the most critical decisions to make in the reporting of MIPS data. There are four choices in the submission of CQMs: Qualified Clinical Data Registry (QCDR), Qualified Registry, EHR, or Claims. There is a vast difference your choice will make on the final MIPS score. If a business entity, consultant, or medical association is advocating one of these paths, due diligence is required to make sure what is best for them is also best for you.

Group vs. Individual Analysis

The decision to report MIPS data to CMS as either an Individual or as a Group can have an immense effect on the final MIPS score. The only way to accurately decide which option is best to choose is through data analysis and reviewing “what if” scenarios. When the decision is made to choose one option over the other, make sure it is based on a true analysis of the underlying data. Most of consulting groups simply do not have the expertise or technology to do this.

The bottom line? The MACRA/MIPS program is much more complex than the Meaningful Use program and the stakes are much higher. Let the buyer beware.

Originally posted at www.mipsconsulting.com


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