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- PLANS & PRICING
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) ended the Sustainable Growth Rate (SGR) formula, which would have resulted in a significant cut to Medicare payment rates for clinicians.
MACRA advances a forward-looking, coordinated framework for clinicians to successfully participate in the Quality Payment Program (QPP), which rewards value in one of two ways:
Four performance categories make up your final MIPS score. Your final score determines what your payment adjustment will be. These categories are:
This performance category replaces PQRS. This category covers the quality of the care you deliver, based on performance measures created by CMS, as well as medical professional and stakeholder groups. You pick the six measures of
performance that best fit your practice.
SHOW LESSThis performance category promotes patient engagement and electronic exchange of information using certified electronic health record technology (CEHRT). This is done by proactively sharing information with other clinicians
or the patient in a comprehensive manner. This may include sharing test results, visit summaries, and therapeutic plans with the patient and other facilities to coordinate care.
SHOW LESSThis performance category measures participation in activities that improve clinical practice. This is a new performance category that includes an inventory of activities that assess how you improve your care processes, enhance patient
engagement in care, and increase access to care. The inventory allows you choose the activities appropriate to your practice from categories such as, enhancing care coordination, patient and clinician shared decision-making, and expansion of practice access.
SHOW LESSThis performance category replaces the VBM. The cost of the care you provide will be calculated by CMS based on your Medicare claims. MIPS uses cost measures to gauge the total cost of care during the year or during a hospital
stay. Beginning in 2018, this performance category will count towards your MIPS final score.
SHOW LESSThere are 5 collection types for Quality measures that you can use:
If you’re an eligible clinician type, you must participate in MIPS if you
MIPS Eligible Clinician Types Clinical Nurse Specialists, Certified Registered Nurse Anesthetists, Qualified Audiologists, Clinical Psychologists, Registered Dietitians or Nutritional Professionals, Physician Assistants, Physical Therapists, Nurse Practitioners, and Occupational Therapists. Physicians (including doctors of medicine, osteopathy, dental surgery, dental medicine, podiatric medicine, and optometry; osteopathic practitioners.)
Physicians are being rewarded for providing high quality care, improvement and reporting to the CMS. With MIPS, physicians have the potential to earn a positive payment adjustment. If physicians decide not to report they will be penalized and lose compensation.