For over a decade we had an annual crisis of uncertainty regarding Medicare physician payments. Under the Sustainable Growth Rate (SGR) formula, physician reimbursement needed to be cut by at least 21% to keep the Medicare program from going under financially. However, each year, Congress postponed these reductions, creating an ever widening chasm between the money paid to providers and the Medicare trust fund. On April 1, 2015, Congress finally and somewhat miraculously ended this annual fiscal crisis by passing “MACRA,” the Medicare Access and CHIP Reauthorization Act of 2015. MACRA ended the Sustainable Growth Rate (SGR) formula for determining the way in which Medicare pays health care providers and establishes a new framework which  CMS hopes will reward “better” care rather than just “more” care (for details see: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-MIPS-and-APMs.html)
MACRA creates a new quality system to determine a provider’s payment called MIPS, the Merit-Based Incentive Payment System. MIPS combines parts of the Physician Quality Reporting System (PQRS), the Value-based Payment Modifier (VBM) and the Medicare Electronic Health Record (EHR) incentive program into one program. Beginning in 2017 and continuing annually, Medicare Part B providers will be assessed a MIPS score (from 0 to 100) based on 4 performance categories. The performance categories are: Meaningful Use of Electronic Health Records –MU (25 points), VBM quality which is determined by performance on PQRS measures (up to 30 points), VBM cost (sometimes called “resource use”) performance (30 points), and a new category named “clinical practice improvement” (15 points).
Figure 1 shows the Components of the MIPS Score and what the formula looks like:


Figure 1

A provider’s MIPS score can significantly affect their annual income. Figure 2 depicts the way in which the MIPS score adjusts the base pay:

Figure 2

Join me next week, same day same time, as I “Explain MIPS: the Merit Based Incentive Program.”  Until then, share your thoughts, comments, and questions:
Caroline Fife, MD
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