Assess, Plan, and Be Flexible for MIPS

Judi Payne, BSM
Published: Tuesday, May 02, 2017
Judi Payne, BSM

Judi Payne, BSM

The shift in healthcare from fee-for-service to value-based reimbursement took a giant leap on January 1, 2017, when the Quality Payment Program (QPP) officially started. Under the QPP, Medicare providers have 2 tracks from which to choose: the Merit-based Incentive Payment System (MIPS) or an Advanced Alternative Payment Model. Most providers, including community oncologists, are expected to fall under MIPS for the 2017 performance year.

Selecting the right measures can mean the difference between success and failure within the program, and substantial revenue is at stake. With careful analysis and planning, community oncology practices can choose measures that are a good fit and hold the most opportunity for revenue enhancement. Here are a few points to consider when selecting MIPS measures.

Figure: Practices Must Choose Value Measures for 2017

Quality Measures

Quality measures examine how well a provider performs certain tasks. Many of the measures that can be specialty-specific are similar to those in the Physician Quality Reporting System and Clinical Quality Measures from the MU program. In past years, performance thresholds were not observed, but in the new program, providers are graded on how well they perform compared with their peers. They can either receive a penalty or a positive payment adjustment based on their performance.

Selection of Quality measures depends on which are supported by the practice’s electronic health record (EHR). For example, McKesson’s iKnowMed EHR supports 16 measures. Providers need to select 6 measures that best match their practice’s services and capabilities.

Working from the list of supported measures, providers should assess their current performance and determine where they are doing well and where they need improvement. Providers should choose a variety of measures where performance is excellent, specialty-specific, or may be in need of minor adjustment

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