The 2018 MIPS program will include Four Performance Categories including the "COST" category
What are some of the major changes for 2018?
1. The final rule reduces the number of clinicians subject to the Merit-Based Incentive Payment System (MIPS) track in 2018 to approximately 622,000. In 2017, CMS exempted providers that had less than $30,000 in Medicare Part B revenue or saw fewer than 100 Medicare Part B patients per year. For 2018, the agency will exempt providers and groups with less than $90,000 in Medicare Part B allowed charges or that care for less than 200 Medicare Part B patients, excluding about 123,000 more clinicians from MIPS.
2. CMS is also easing MIPS burdens by offering bonus points to small practices and groups that treat a large share of complex patients. Small practices (those with 15 or fewer clinicians) can earn five additional points to their MIPS final score if they submit data on at least one performance category. Additionally, CMS will award providers up to five bonus points if their patient population is deemed particularly complex, as measured by a combination of Hierarchical Conditions Category (HCC) risk scores and the number of dually eligible patients treated.
3. Clinicians are allowed to continue using 2014 Edition Certified Electronic Health Record Technology (CEHRT), rather than upgrading to 2015 Edition technology, to report the Advancing Care Information (ACI) transition measures (the Modified-Stage 2 equivalent measure set). Clinicians that exclusively use 2015 CEHRT to report the ACI objectives and measures (the Stage 3 equivalent measure set) could be eligible for a 10 percent bonus score.
4. CMS will quadruple the reporting period for the quality performance category to a full calendar year and increase the data completeness requirements to 60 percent for EHR, registry and claims-based submission methods. Notably, CMS will begin to assess providers on cost measures in 2018—a significant change from the proposed rule, which initially delayed the cost measures entirely until 2019. The cost category will be weighted at 10 percent of the MIPS final score in 2018 and will increase to 30 percent in 2019. Collectively, quality and cost performance will likely become a key determinant of high-performing providers.
5. The final rule raises the performance bar to avoid payment penalties in MIPS slightly overall. In order to avoid a payment penalty in 2019, clinicians need to earn three points across the three MIPS categories in 2017. For payment adjustments in 2020, CMS is raising that threshold to 15 total points for the 2018 performance year. This is still a fairly low bar to clear and may dilute bonuses in 2020 for high performers.
(Source, HealthData Management, 11/2017)