Do you know how MIPS factors into your practice? AOA has answers.

MIPS tips and MORE: Be in the know

Implementation of Medicare's new Quality Payment Program (QPP) could leave doctors with more questions than answers, but AOA is committed to setting the record straight and helping doctors succeed.

Although Medicare doctors now know their MIPS eligibility, that in and of itself evokes questions. AOA has answers.

Toward the end of April, the Centers for Medicare & Medicaid Services (CMS) began notifying Medicare physicians of their eligibility for participation under the new Merit-based Incentive Payment System (MIPS), one of two CMS QPP tracks launched Jan. 1. This corresponded with an AOA member alert containing additional guidance, as well as a CMS tool that allows doctors to determine MIPS eligibility.

It's now clear that nearly two thirds of all Medicare physicians will be exempt from MIPS requirements, including two thirds of doctors of optometry. Most doctors of optometry (60 percent) are excluded based on the low-volume threshold—Medicare Part B allowed charges less than or equal to $30,000/year, or 100 or fewer Medicare Part B patients—while another 6 percent are excluded as newly enrolled physicians. But that doesn't mean excluded doctors should tune out MIPS altogether. 

Frequently, private payers adopt and adapt Medicare policies, and consequently, it's possible that a MIPS-style program could be implemented among private insurance. Furthermore, CMS intends to release proposed rules for the 2018 MIPS program in the coming weeks that may extend the flexibility already employed by MIPS participants, or alter future requirements. All of which means it's important for Medicare physicians to stay up to date with the latest information. 

To equip doctors, AOA has developed resources for MIPS participants, including:  

Although Medicare doctors now know their MIPS eligibility, that in and of itself evokes questions. Therefore, AOA offers an upcoming webinar that will provide a MIPS overview and the opportunity to ask practice-specific questions of AOA's Quality Improvement and Registries Committee Chair Zachary McCarty, O.D., and Immediate Past Chair Jeff Michaels, O.D.

Want to attend?
MIPS: Have Questions? We've Got Answers
When: 9 p.m., ET, June 12
Click here to register now.

MIPS eligible? What to know

Participating physicians will be familiar with certain aspects of MIPS as components of the Physician Quality Reporting System (PQRS), Value-based Modifier (VBM) and Medicare EHR Incentive Program (meaningful use) made their way into this new QPP that's still focused on quality, resource use and continued certified EHR (CEHRT) use. These new performance categories are titled Quality (PQRS), Clinical Practice Improvement, Advancing Care Information (meaningful use) and Resource Use/Cost (VBM). 

Here's how it works—MIPS is scored on a scale of 0-100, based on how well physicians perform in each category. Each of these categories is weighted differently, and CMS will adjust from year to year. A MIPS final score above the CMS Threshold Performance Score (TPS) will earn physicians a payment increase, and a decrease if below. Up to 4 percent of 2019 Medicare payments are earned/penalized by 2017 participation.

For 2017, the performance categories scores are:  

  • Quality (60 percent of overall MIPS score)
    Physicians need to report 6 quality measures; one of which must be a High Priority Measure or Outcomes Measure. Click here for more.

  • CPIA (15 percent of overall MIPS score)
    Designed to demonstrate physicians' role in public health initiatives, activities are weighted medium and high, and worth different scores based on practice size, location and patient population. Registry reporting is heavily emphasized and can help physicians attest. Click here for more.

  • ACI (25 percent of overall MIPS score)
    This category is determined by three scores that determine physicians' use of CEHRT. Physicians must perform each of four objectives to achieve a base score—perform a Security Risk Analysis, e-prescribe, provide a patient portal, and demonstrate health information exchange—and a performance score is generated by how often and successfully the measure is performed. A bonus score is achieved by reporting to a registry, such as AOA MORE. Click here for more.

  • Resource use/cost (0 percent in 2017)
    Cost will eventually count toward 30 percent of physician's total score, decreasing quality to 30 percent by 2022; however, in 2017, nothing is required from physicians in this category. 

For 2017, physicians have several ways to participate in MIPS' first year, and AOA MORE can be a useful tool in meeting program requirements. Click here to enroll now.

May 23, 2017

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