The 2015 Medicare Access and CHIP Reauthorization Act (MACRA) repealed the Sustainable Growth Rate payment methodology for physician practices. The final rule merges major features of the Physician Quality Reporting System (PQRS), Electronic Health Record Meaningful Use (EHR MU), and Value Based Payment Modifier (VBPM) program requirements into a new payment incentive program called the Merit-Based Incentive Payment System (MIPS).

MIPS will begin January 1, 2017. MIPS CAHPS will replace the current PQRS CAHPS survey and groups can voluntarily collect MIPS CAHPS beginning with the 2017 performance year. The first data collection is expected to begin in November 2017 using a MIPS CAHPS survey that aligns with the PQRS CAHPS survey in design and administration.

Measuring Performance in MIPS

MIPS promotes better care, healthier people and smarter spending by evaluating eligible clinicians (ECs) using a Composite Performance Score that incorporates EC performance on:

  • Clinical Practice Improvement (CPIA)
  • Quality (includes MIPS CAHPS)
  • Resource Use/Cost
  • Advancing Care Information

Category Weighting for Composite MIPS Performance Score

  2019 MIPS Weights 2020 MIPS Weights 2021 MIPS Weights
Clinical Practice Improvement (CPIA) 15% 15% 15%
Quality (includes MIPS CAHPS) 60% 50% 30%
Resource Use/Cost not included 10% 30%
Advancing Care Information 25% 25% 25%

Based on the Composite Performance Score, ECs may receive an upward payment adjustment, a downward payment adjustment, or no payment adjustment. It replaces the Sustainable Growth Rate that calculated payment schedules using pure numbers – not quality or improvement metrics.

Eligible clinicians identified as physicians, physician assistants (PAs), nurse practitioners (NPs), clinical nurse specialists and certified registered nurse anesthetists will continue to have the option to report as an individual or as a group. As proposed, eligible clinicians will be required to submit at least one measure within the Quality Performance category, attest to one activity within the Clinical Practice Improvement Performance category, or report the five measures required under the Advancing Care Information Performance category in order to avoid a negative payment adjustment for the transition year (2017). To earn a positive adjustment under MIPS, eligible clinicians are required to submit six measures: one cross-cutting measure and one outcome measure, or another high priority measure if an outcome measure is not available within the Quality Performance category, earn 40 points within the Clinical Practice Improvement category, and report the five measures required under the Advancing Care Information Performance category.

Patient Experience and MIPS CAHPS

Starting in January 2017, eligible clinicians submitting as a group will have the option to voluntary administer the CAHPS for MIPS (MIPS CAHPS) survey. The MIPS CAHPS survey will replace the PQRS CAHPS survey and include the same survey questions.

The MIPS CAHPS survey is a voluntary measure for year one and counts as one of the six required measures for a positive adjustment. The survey counts as one measure within the Quality Performance category and earns 20 points as a High Point measure under the Clinical Practice Improvement category. Administration of MIPS CAHPS will occur November – February and use a mail followed by telephone methodology (similar to the approach for PQRS CAHPS administration).

Press Ganey anticipates MIPS CAHPS administration will be mandated for the 100+ EC groups in the near future. Press Ganey is a CMS-approved vendor to administer MIPS CAHPS in 2017.

To Learn More About MIPS CAHPS, Call Us At 800.232.8032 or Contact Us.

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