As the ACA (Affordable Care Act) is being reshaped in Washington, the Merit Based Incentive Payment Program (MIPS), a part of the overwhelmingly bipartisan-supported MACRA (Medicare Access and CHIP Reauthorization Act) program, is being actively implemented regardless of potential changes to the ACA.
This program, which went into effect in 2017, replaced three previously existing pay-for-performance programs: Meaningful Use (MU), the Value-Based Payment Modifier, and the Physician Quality Reporting System (PQRS).
These are replaced by metrics consisting of Quality, similar to PQRS; Cost, similar to Value-Based Payment Modifier; ACI, similar to MU; and the new Clinical Practice Improvement Activity (CPIA). These metrics will be described in one score.
Depending on the score, providers will see up to a 4% increase or decrease in the Medicare fee schedule in 2019, based on 2017 results. Fee schedule spread gradually increase to 9% up or down by 2022.
Columbia’s providers belong to the ACO, NewYork Quality Care. “Luckily, being in an ACO will automatically give us significant points in CPIA and cost categories,” said Shunichi “Nick” Homma, MD, FACC, ColumbiaDoctors chief medical officer. Additionally, the quality metrics for MIPS are identical to those for ACO patients. As such, our efforts to achieve success in MIPS is enhanced by ACO participation.
Associate chief medical officer Siqin “Kye” Ye, MD, chief quality officer Teri Gillette, and healthcare policy specialist Julie Veluya are preparing to reach out to each department and division to provide group-level updates on the status of their ACI components. “We look forward to working together to be sure to succeed in MIPS,” Dr. Homma said.