Merit-based Incentive Payment System Final Rule: CAHPS and Patient Experience

Added on Oct 20, 2016

Merit-based Incentive Payment System Final Rule: CAHPS and Patient Experience
From Industry Edge October 2016

On October 14, the Centers for Medicare & Medicaid Services (CMS) finalized the Medicare Quality Payment Program that implements the Merit-based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model (APM) incentive payment provisions. The final rule with comment period takes into account feedback received during the proposed rule comment period and implements transitional policies to focus the initial years of the program on encouraging participation, educating clinicians and continuing to place the patient at the center of the health care system.

MIPS participation will begin on January 1, 2017 as initially proposed. A MIPS CAHPS survey will replace the current PQRS CAHPS survey, and groups can voluntarily collect MIPS CAHPS survey data 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.

To participate in MIPS in the first performance year (2017), eligible physicians can choose from three different paths to avoid a negative payment adjustment and possibly achieve a positive payment adjustment in 2019. Minimum participation involves submitting one quality measure or one improvement activity for any point in 2017. Eligible clinicians will continue to have the option to report as individuals or as groups.

Three performance categories will be used to calculate performance under MIPS: Quality, Improvement Activities and Advancing Care Information. The MIPS CAHPS survey measure will count as one measure under the Quality performance category, as well as contribute to the Improvement Activities category as a high-weighted activity.

There are additional surveying and improvement activities that gain points under the Improvement Activities category. As an example, regularly assessing the patient experience of care through surveys is considered a medium-weight activity under the Beneficiary Engagement subcategory.

To be best positioned for changing regulatory requirements and payment models, Press Ganey recommends a surveying strategy that incorporates ongoing surveying for deep data, targeted opportunities and comprehensive performance improvement. We continue to offer a full suite of medical practice patient experience surveys and will offer the new MIPS CAHPS survey following official certification.

Press Ganey subject matter experts will review MIPS implications and outline the patient experience survey options for meeting MIPS reporting requirements in a session at the Press Ganey 2016 National Client Conference, which will take place Nov. 2–4 in Orlando, Fla. The session, “Preparing for MIPS: CAHPS Updates for Medical Group Leaders,” will be held on Friday, Nov. 4, from 9:45 to 10:45 a.m. EST. In addition, we will offer a “Preparing for MIPS” webinar in early December. Look for more details at in late November.