Business of Practice 2017: Maximize Your MIPS Success

Chase Doyle

August 2017, Vol 7, No 8: Special Edition – Highlights from ASCO 2017 - Professional Development, Reimbursement Issues


Chicago, IL—As the battle over the Affordable Care Act rages on, Congress remains steadfast in its support of the Quality Payment Program. Even though Medicare reimbursement will not change until 2019, the new era of the Quality Payment Program begins this year. At the 2017 ASCO annual meeting practice management sessions, Stephen S. Grubbs, MD, FASCO, ASCO’s Vice President of Clinical Affairs, described the requirements of the Quality Payment Program and shared strategies for optimal reporting.

“Many of your current activities will qualify for scoring, but it’s going to take thoughtful planning and strategy to improve your patient care and maximize your MIPS [Merit-Based Incentive Payment System] score,” said Dr Grubbs. “We have to be paid properly to have a functioning practice and take care of our patients, but the goal here is also to increase the quality of care.”

MIPS Reporting Requirements

As Dr Grubbs reported, physicians can be reimbursed through 1 of 2 systems—the Alternative Payment Model or MIPS. The majority of individuals and practices will be paid via the latter, which started in 2017. Every year, the Centers for Medicare & Medicaid Services will make adjustments to providers’ Physician Fee Schedule, depending on their MIPS Composite Score, which is calculated by performance in the following 3 categories:

  • Quality (60%)
    The practice or individual must report on 6 applicable measures (including at least 1 outcome measure). What’s more, said Dr Grubbs, at least 50% of eligible patients per measure must be reported on, and this percentage will increase every year until it is 90%. “This is a big deal, because it means we’re going to have to electronically capture our measurement results,” Dr Grubbs observed. “We can no longer do it manually”
  • Improvement activities (15%)
    This category assesses participation in activities that improve clinical practice. Physicians have 90 potential activities to choose from, and must perform between 1 and 4 activities depending on the size of the practice. Reporting is done by attestation
  • Advancing care information (25%)
    This category replaces the Electronic Health Record (EHR) Incentive Program for eligible professionals, also known as Meaningful Use. The score is calculated based on security, electronic prescribing, and patient electronic access.

Strategically Reporting Activities

As physicians begin reporting for MIPS, they are often surprised by how many activities they are already doing, said Dr Grubbs.

“Take advantage of these existing activities in your reporting so you can get properly paid, but this is also about improving the quality of care for your patients,” Dr Grubbs advised. “When you consider needed quality improvements, take a moment to see if those improvements are awarded in MIPS, particularly the Improvement Activities category.”

According to Dr Grubbs, many physicians are not maximizing their EHR capabilities, and MIPS reporting is an opportunity to optimize their record. Even administrative functionalities, such as secure messaging to patients for appointments or refills, can increase your MIPS score, he noted.

Group versus Individual Reporting

If reporting individually in the Quality category, each clinician must meet a 20-case minimum order for a measure to be scored while reporting on 50% of cases. If reporting as a group, however, the entire group contributes to the 20-case minimum. Similarly, in the Improvement Activities category, clinicians reporting individually must perform 1 to 4 improvement activities for full score. For those reporting as a group, however, anyone in the group can contribute to required activities. Finally, in the Advancing Care Information category, individuals would have a hard time qualifying for bonus points, said Dr Grubbs, whereas reporting as a group increases the quantity of events for performance scoring.

“I have a hard time figuring out why I would want to report as an individual in this new system,” Dr Grubbs observed.

Bonus Points

In the Quality category, there are high-priority measures that award extra points for reporting (1-2 extra points each). By completing the quality reporting entirely electronically, bonus points are also awarded. Physicians who use their EHR to perform an improvement activity will receive a 10% bonus in the Advancing Care Information category, and additional bonus points are available for reporting through a public health or clinical data registry (ie, Quality Oncology Practice Initiative).

Dr Grubbs encouraged physicians to “make every activity count” by strategically picking activities that award points in multiple categories. The goal is to use this system as efficiently as possible by picking the right activities to receive credit in different areas, he explained. Medication reconciliation, for example, is a Quality measure and an Improvement Activity, and if documented with EHR, can award Advancing Care Information points as well.

“2017 is the transition year,” Dr Grubbs concluded. “This is your chance to practice, to develop strategies, and to see if you can use your EHR to capture as many data as you can. Use your time wisely, because you need to be ready by 2018 when cost will be counted towards the final score.”