Ongoing Surveying and Performance Improvement Leads to Success under MIPS

Added on Dec 15, 2016

Ongoing Surveying and Performance Improvement Leads to Success under MIPS
Industry Edge December 2016

The Centers for Medicare & Medicaid Services (CMS) has released its final rule implementing the Medicare Quality Payment Program and the Merit-based Incentive Payment System (MIPS) payment model. Under the final rule, MIPS will evaluate eligible clinicians (ECs) using a composite performance score that incorporates EC performance on four measures: Quality, Resource Use/Cost, Advancing Care Information and Clinical Practice Improvement Activities (CPIA). Ongoing measurement of the patient experience and implementation of performance improvement activities can help medical practices earn points in the CPIA category, thereby helping them to succeed under MIPS.

According to CMS, CPIA will count for 15% of the category weighting for the composite performance score for the 2019–2021 MIPS payment years. Based on the composite performance score, ECs may receive an upward payment adjustment, a downward payment adjustment or no payment adjustment.

Under MIPS, ECs or group practices that have 15 or fewer clinicians, are non-patient-facing or are located in rural areas must earn 20 points to get full credit under CPIA; all other MIPS ECs must earn 40 points. Medium-weight activities are worth 10 points each, while high-weight activities are worth 20 points each. Organizations focusing on the patient experience likely are already conducting the following improvement activities:
  • Patient safety and practice assessment by participating in MIPS CAHPS, resulting in a high weighting
  • Beneficiary engagement by collecting and following up on patient experience and satisfaction data on beneficiary engagement, including development of an improvement plan, resulting in a high weighting
  •  Expanded practice access by collecting patient experience and satisfaction data on access to care and development of an improvement plan, resulting in a medium weighting
  • Expanded practice access by collecting patient experience and satisfaction data on access to care and development of an improvement plan, resulting in a medium weighting
  •  Beneficiary engagement by regularly assessing the patient experience of care through surveys, advisory councils and/or other mechanisms, resulting in a medium weighting

By continuing with their current surveying and improvement activities at a high level of performance, organizations will be strategically positioned to satisfy many of the CPIA point requirements.

More information about MIPS and CPIA is available here.