With performance measurement now underway, CMS officials unpack MIPS categories

Molly MacHarris, program lead at the Quality Measurement & Value-Based Incentive Group at CMS, speaking at HIMSS17 on Tuesday.

ORLANDO – The rule was only finalized four months ago, but we're already in the initial performance year for the new Merit-based Incentive Payment System, which ushered in sweeping changes for how clinicians get reimbursed as part of MACRA. On Tuesday at HIMSS17, two officials from the Centers for Medicare and Medicaid Services offered a detailed primer on two of the more technology-intensive components of the program.

With the new payment framework, "clinicians can pick their pace," said Molly MacHarris, program lead at the Quality Measurement & Value-Based Incentive Group at CMS.

The agency has heard from stakeholders that "we were moving a little bit too fast," she said. "We wanted to take a step back and ensure that anyone who wants to participate in the program can participate."

That said, she added: "The more active a clinician's participation is in the program, the higher their potential score."

Medicare clinicians who participate in MIPS will be reimbursed based on a score of zero to 100, determining whether they receive a bonus or a penalty. The score is weighted according to four components: Quality (accounting for 60 percent in year one), Cost (zero percent for the 2017 transition year), Advancing Care Information (25 percent) and Clinical Practice Improvement Activities (15 percent).

The session on Tuesday focused on the latter two, ACI and CPIA, which depend especially on use of certified EHR technology.

[Also: CMS offers insights on MIPS, APMs in MACRA's payment reform]

The performance period for this first transition year can be as little as 90 days or as much as a year, but data must be submitted to CMS by the end of Q1 2018, said MacHarris. By the middle of that year, CMS will give feedback on performance, and then payment adjustments – whether bonuses or 4 percent penalties – will begin in 2019.

Those eligible professionals who participated in meaningful use will be familiar with the approach to ACI, said Elizabeth S. Holland, senior technical advisor at the Division of Health Information Technology, Quality Measurement & Value-Based Incentive Group at CMS.

Advancing Care Information, she said, is "based on, but not identical to the EHR Incentive Program." (Which continues on, incidentally, for hospitals and Medicaid-eligible professionals – although the latter group can participate in both MIPS and MU.)

That component is calculated using a base score, a performance score and a bonus score. The base score measures clinicians on security risk analysis, e-prescribing, patient access and sending of summaries of care. Performance score assesses patient-specific education, view/download/transmit, secure messaging, patient-generated data and more. Bonus scores can be improved by more advanced capabilities, such as chronic care management and capture of patient-reported outcomes.

As for Improvement Activities, clinicians can choose from more than 90 initiatives grouped in nine subcategories: Expanded Practice Access, Population Management, Care Coordination, Beneficiary Engagement, Patient Safety and Practice Assessment, Participation in an Alternative Payment Model, Achieving Health Equity, Integrating Behavioral and Mental Health and Emergency Preparedness and Response.

Much more detailed explanations of how the component scores are weighted and calculated can be found at CMS.gov.

Twitter: @MikeMiliardHITN