Protect MIPS Scores and Secure Maximum Financial Opportunity

February 21st, 2019 by

Every Medicare Part B service you perform from now on is impacted by MIPS. Yes, the MIPS scores you earned in 2017 are now impacting your payment adjustments for 2019 services – whether as a meager incentive or a penalty depending on how your clinicians performed in 2017.

The stakes are higher in 2019 with a 150% increase in the maximum financial opportunity. Exceptional Performers achieving MIPS scores >75 will be rewarded with a maximum payment incentive of 4.7%, a 150% increase over 2018. This means that an organization with $5M in Medicare Part B services can earn an additional $6,953 for each point over 75. Reach a score of 85, and you can earn 10X the bonus. A score of 95 can earn 20X the bonus, or $123K! We can help you quantify the value of your MIPS points today!

For top performers it seems to be an easy win, however with changes in the 2019 MIPS program it’s actually a lot harder than you think to maintain your high scores.  

Here are some tips on how you can protect your scores based on our real-world experience with tens of thousands of clinicians.

  1. Pay attention to the Promoting Interoperability (PI) category, as it’s much harder to earn 25 points in 2019. Remember, PI measures are now all performance-based, some measures have been consolidated/changed, base measures have been removed, and bonus points have been reduced. For deeper analysis, read our blog on Dissecting the MIPS Promoting Interoperability Category in 2019. Here’s what you can do to protect your score from a PI perspective:
    1. Upgrade to 2015 CEHRT as soon as possible to maximize the number of 90-day reporting periods you have to choose from for final reporting.
    2. Focus on consistently following workflows to perform at a higher rate, as opposed to checking the box to get the numerator of one for a measure.
    3. Study the PI measure specifications to determine what types of documentation you may not have thought of that can be leveraged. See the “2019 Promoting Interoperability Measure Specifications” CMS published in the QPP Resource Library last December.
    4. Work with SA Ignite to get an early read on your PI score and identify where you may need to make some early adjustments.
  2. Re-visit your strategy for selecting Quality measures, as CMS has made this category more competitive in 2019. Requirements have been modified on 23 measures, benchmarks have increased on 58% of the measures, and the number of measures that are now topped out or capped at 7 points has more than doubled. For a deeper dive, read our blog on What You Need to Know About 2019 MIPS Quality Benchmarks. Here’s what you can do to protect your score from a Quality perspective.
    1. Review whether your priority measures have been impacted by the 2019 Quality measure updates. Access the Quality Measure Specifications files on the QPP Resource Library to see the details for each submission method.
    2. 2019 offers the opportunity to boost your scores by submitting via multiple methods for the same measure. Compare benchmarks for measures to determine the best possible options for your organization and analyze your performance data throughout the year.
    3. Find measures that apply to MIPS and other value-based care programs, set goals that will drive the highest value for your clinicians and organization, and measure individual clinician performance. See how SA Ignite can help in this one-minute video.
  3. The MIPS Cost category is now worth 15% in 2019, up from 10% in 2018. In addition to the two core measures (Medicare Spending Per Beneficiary and Total Per Capital Cost) CMS introduced 8 episode-based cost measures that will impact specialists and the groups in which they participate. Here are some things you can do to address MIPS Cost.
    1. Download the 2019 MIPS Cost Measure Information Forms from the QPP Resource Library.
    2. Review the new episode-based cost measures and identify which clinicians in your group may be impacted.
    3. Educate specialty clinicians likely to be attributed to episode-based cost measures to give them a sense for how they’ll be measured.

There is no doubt that MIPS is getting more competitive. Scores are expected to erode by 12% – 16% due to changes in the 2019 Quality Payment Program rule. SA Ignite helps healthcare organizations earn top scores in MIPS with our IgniteMIPS software and services. Learn how to boost your MIPS scores by watching this one-minute video.

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