Article

Digesting MIPS

From ACI to VBM, an explanation of the need-to-know terms.

ASAP, FYI, DIY, LOL, SUV … we are all inundated with acronyms in our daily lives, and health care is no exception. With the final rule regarding the Merit-based Incentive Payment System (MIPS), it seems we are now surrounded by alphabet soup. To try and make sense of all this, below I discuss common MIPS acronyms, the meaning behind them, and how they impact your practice.

ACI – Advancing Care Information – a component of MIPS that replaces meaningful use. The ACI consists of individual measures that will count toward a practice’s MIPS score. A practice’s ACI score will be 25% of the eligible professional’s MIPS score in 2017. A complete list of measures is located at https://qpp.cms.gov/measures/aci .

ACO – Accountable Care Organization – physicians who collaborate as a group to provide high-quality care to Medicare patients. If an ACO is successful in providing quality care while spending less, they are able to share in the cost savings.

APM – Alternative Payment Model – type of payment reform that provides incentives to participants for providing high-quality, low-cost care.

CEHRT – Certified electronic health record technology – a certification issued by the Centers for Medicare and Medicaid Services and the Office of the National Coordinator for Health Information Technology to electronic health records that pass certification criteria. To successfully report for meaningful use, a practice must use a product with this certification.

CMS – Centers for Medicare & Medicaid Services – a government entity that administers the Medicare program and works with states to administer the Medicaid program. CMS also institutes and monitors government regulatory programs such as meaningful use, Physician Quality Reporting System, Value Based Modifier, and MIPS.

CQM – Clinical quality measures – measures that are a component of meaningful use; however, these measures will not be part of MIPS.

EHR – Electronic health records – an electronic version of a patient record.

EP – Eligible professional – a provider who is eligible to participate in government regulatory programs. Examples of an EP include a doctor of medicine, doctor of optometry, physician assistant, or nurse practitioner.

eRx – e-Prescribing program – a regulatory program that incentivized providers for e-prescribing and penalized providers for not achieving the program requirements or not reporting. The e-Prescribing program ended in 2013, becoming a component of meaningful use.

GPRO – Group Practice Reporting Option – an option of reporting for eligible professionals when participating in the Physician Quality Reporting System. This option is now called “Web Interface” and will be used for reporting for MIPS.

HHS – Department of Health and Human Services – a cabinet-level department of the federal government that provides essential human services and has a goal of protecting the health of Americans. The Centers for Medicare & Medicaid Services and the Office of the National Coordinator for Health Information Technology are agencies under the HHS.

IA – Improvement Activities – a component of MIPS that outlines numerous activities that practices can participate in. Examples of activities include expanded practice access, beneficiary engagement, patient safety, and care coordination activities, among others. A practice score in IA will be 15% of the eligible professional’s total composite MIPS score in 2017. These are sometimes also referred to as “Clinical Practice Improvement Activities” (CPIA). You can find a complete list of IA at https://qpp.cms.gov/measures/ia .

MACRA – Medicare Access and CHIP Reauthorization Act of 2015 – this act, signed into law in April 2015, repealed the Sustainable Growth Rate and outlined MIPS, which will determine Medicare reimbursement for eligible professionals.

MIPS – Merit-based Incentive Payment System – outlined in the Medicare Access and CHIP Reauthorization Act of 2015. The final rule on MIPS was signed into law October 2016 and began in reporting year 2017. MIPS consists of four components: Quality, Cost, Advancing Care Information and Improvement Activities; however, Cost will not be considered in an eligible professional’s composite score in 2017. Eligible professionals will report to the Centers for Medicare & Medicaid Services their performance in each of these categories. They will be assigned a composite score that will determine if the eligible professional will receive a negative, neutral, or positive payment adjustment to their reimbursements for 2019 and future years.

MU – Meaningful use – a regulatory program that began in 2011 that required eligible professionals to meaningfully use a certified electronic health record system. The program began with an incentive to adopt EHR, but it eventually became a penalty program for those who did not adopt or meet the criteria for meaningful users. MU is now the Advancing Care Information component of MIPS.

MSPB – Medicare Spending per Beneficiary – the amount Medicare spends per year for each beneficiary.

NPI – National Provider Identifier – a unique 10-digit number assigned to an eligible professional or supplier.

ONC – The Office of National Coordinator for Health Information Technology – an agency of the Department of Health and Human Services that administers the criteria for certification and standards of health information technology use and security.

PQRS – Physician Quality Reporting System – a regulatory program that began in 2007 as an incentive program and moved to a penalty phase in 2012. Originally named the Physician Quality Reporting Incentive Program, it will now be the Quality component within MIPS and will be 60% of an eligible professional’s score in 2017.

PY – Payment year – the year in which an eligible professional receives reimbursement based on data that was reported in the reporting year. The reporting year is often two years prior to the PY so the Centers for Medicare & Medicaid Services can collect and analyze the data.

QCDR – Qualified clinical data registry – a method of reporting Physician Quality Reporting System or Quality outcomes. The IRIS Registry is one of the options for QCDRs that collects, aggregates, and reports quality measures for eligible professionals.

RY – Reporting year – the year in which an eligible professional collects and reports data on government regulatory programs. The reporting year differs from the year that you will receive the reimbursement adjustment, which is the payment year.

SGR – Sustainable growth rate – implemented in 1997 to attempt to control Medicare spending. This was replaced when MACRA was passed.

TIN – Taxpayer identification number – a unique number assigned by the Internal Revenue Service to a business.

VBM – Value-Based Modifier – a regulatory program that began in 2013 for some practices that is based on the quality of care compared to the cost of care. Depending on performance, an eligible professional would receive a negative, neutral, or positive adjustment. VBM will now be the Cost component within MIPS.

Conclusion

The acronym list can be confusing, but many available resources can help you sort it out.

Find a complete acronym list at http://tinyurl.com/OPMIPS17 and more information on MIPS at https://qpp.cms.gov/measures/performance . OP