May 2018 marked the tenth anniversary of American Ninja Warrior, the series that tapped into the intensity of the American competitive spirit and inspired a whole new growth segment in the fitness industry. MIPS is CMS’ American Ninja Warrior, inspiring the movement in healthcare from volume to value. The 2019 Proposed Rule for the Quality Payment Program (QPP) signifies just how serious Seema Verma’s administration is about turning healthcare providers into value-warriors.
Expectations are Becoming Clear
There is a clear, and increasingly difficult path for would-be warriors to achieve the coveted distinction of American Ninja Warrior. With the 2019 proposed rule, CMS staked out a more defined, predictable and continuously expanding path for MIPS, as evidenced in the multi-year direction for the remainder of the 5-year transition period.
CMS set expectations for a 30-point performance threshold for 2019 and a steady 15 point increase each year, reaching 60 points in year 2021. The mean or median score, which is expected to be at least mid to upper 60s will be used to determine the performance threshold post the transition period.
Cost and Quality Weights
Extending the transition period to 5-years called into question the trajectory of the weight of MIPS Cost and Quality. CMS proposes a 15% weight for Cost in 2019, and states clearly that we can expect Cost to increase by 5% and Quality to decrease by 5% each year during the transition period, reaching the 30/30 split in 2022.
MIPS Transition is Intensifying
As individuals progress through the qualifying rounds and stages in American Ninja Warrior, the obstacles change and increase in difficulty until only the fittest warriors are seated in the upper ranks. For MIPS, the 2019 performance year represents an important pivot point, from slow ramp up to a program with teeth. CMS is eliminating some of the mechanisms that made it easy for organizations to avoid a penalty and earn high scores with limited effort.
Promoting Interoperability (PI)
This category moves from an easy 25 points to one that requires significant organizational focus and performance to score above 20 points. With the removal of the easy 50 base points, providers must work harder to achieve full credit on a fewer number of measures.
Bonus points are being removed from the Quality, Promoting Interoperability, and Improvement Activities categories in 2019. CMS also states that they plan to eliminate even more bonus points in 2020.
Bending the cost curve is the biggest challenge in healthcare – American Ninja Warrior is to MIPS, as the Warped Wall is to MIPS Cost. The weight of this category continues to climb and 8 new episode-based cost measures will be introduced in 2019, according to the proposed rule.
The HHS Secretary expanded eligible clinicians for 2019 adding four new clinician types, with the possibility of more depending on analysis of the available quality measures. CMS also broadened participation by an estimated 40K-60K by allowing clinicians that would otherwise be exempt, to opt-in.
MIPS is Gaining Acceptance
American Ninja Warrior caught on like wild-fire. With MIPS, there has been resistance from leaders in the healthcare industry, but the tide is turning toward support for the program. The American Medical Group Association (AMGA) lobbied key members of Congress to send Administrator Seema Verma a letter asking her to expand the MIPS program by lowering the low volume threshold. “Now that we are about to enter the program’s third year, it’s time to recognize that continuing to exclude a substantial percent of providers impedes moving the Medicare program to paying for value, which the Congress envisioned in overwhelmingly passing MACRA,” said Jerry Penso, M.D., M.B.A., AMGA president and CEO.
Physicians testified to the United States Congress to keep MIPS and refine it as opposed to scrapping it. These providers recognize MIPS as a vehicle to move the industry toward value-based care.
American Ninja Warrior honed the competitive spirit of Americans young and old, and shaped a new way of thinking about fitness. The Quality Payment Program, including MIPS and Advanced APMs is intended to re-shape healthcare from fee-for-service to value-based care. CMS designed the QPP to be disruptive, using quality measurement and public rankings tap into the competitive nature of healthcare providers, and it’s working.
Like American Ninja Warrior the intensity of the goals and objectives is steadily increasing as the program matures. True warriors embrace the challenge head on and undertake brutal training regimens to build strength and muscle memory required to compete and win.
Learn how you can create value-warriors in your organization using MIPS as a change enabler. Access the Healthcare Playbook: Making MIPS a Change Enabler.