What You Need to Know About MIPS

MIPS stands for Merit-Based Incentive Payment System and it will be introduced in 2019. The program is designed to provide annual updates to physicians and is a payment mechanism. These updates will provide feedback on performance in four main categories: resource use, clinical practice improvement activities, quality, and meaningful use of an electronic health record system.

How Is It Different From SGR?

SGR stands for sustainable growth rate and it is a flawed system. MIPS is replacing that system and will improve in areas where SGR lacked. One of the things it will do differently is adjusting payments based on individual performance. In the SGR system, there is a set arbitrary aggregate spending target. This proposed a problem because it caused annual patched to prevent cuts. The MIPS system will not set these spending targets so this issue is avoided.

How Will the New System Work?

MIPS is a program that surgeons and physicians can take part in. By opting in to the system, they will receive a composite performance score. This score is between 0-100. The score is evaluated and determined by looking at the four factor previously mentioned. The scores received will be compared to the mean or median of all scores received by MIPS professionals during that period or the one before. If their score falls below the threshold, they will receive a payment adjustment that is negative. The opposite is true as well: if they get a score that is above the threshold, they will get a positive payment adjustment. This threshold is changed every year. If a professional does not score well one year, it will not be included in their calculation for the next. Only current information is evaluated with MIPS.

Do You Have to Participate?

In a short answer, no. However, if you do not participate in MIPS, you must meet other requirements. There is only one way to opt out of being a part of MIPS. If a professional is in line with the APM (Alternative Payment Model) requirements they can be excluded from th MIPS assessment. There is no way to be avoided being evaluated entirely.

What Does This Mean for the Future?

MIPS will be the new standard in a few short years. This is a positive thing and you should start preparing for the changes now before they become effective. Of course, you should always aim provide quality service to your customers, which is the entire focus of this program. At the root of it are the customers. Follow current regulations for now and prepare for what is to come in 2019.

If you are interested in learning more about how MIPS with affect you in New Jersey, contact eSOZO Computer and Network Services via info@esozo.com or (888) 376-9648. They will be happy to help answer any questions you have about the program and help you prepare for the changes.

Author: Aaron White, Date: 2nd December 2016