Three Reasons Why You Need MIPS Warriors September 26th, 2018 by

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What is a MIPS Warrior, and where can I get one?! A MIPS Warrior is a healthcare provider (physician or clinician) with a focused mission to carry out quality improvement initiatives that increase the MIPS score and benefit the broader, organizational mission for value-based care. You can’t buy MIPS Warriors in stores – You have to cultivate and train them from within, and it’s always best if they’re part of a team. Learn how you can turn your clinicians into MIPS Warriors in this healthcare playbook on Making MIPS a Change Enabler.

A common misconception is that MIPS Warriors only exist in primary care. The reality is that every clinician (specialist or otherwise) can and should be contributing to your value-based care mission, of which MIPS is a part. Here are three reasons why you need MIPS Warriors in your organization, and how you can engage all your clinicians in the mission.

1. Your organization aced the performance threshold in 2017, but MIPS is getting tougher

The 2017 and 2018 performance years for MIPS were designed to be transitional. The performance threshold was artificially low, the cost category was not in play, and measure benchmarks were relatively easy to achieve for primary care. In multi-specialty organizations, specialists were left out in the cold, but it didn’t necessarily matter – The average MIPS scores were in the mid-70’s, and the expectation for 2018 is about the same.

2019 is a different story. CMS released its proposed 2019 MIPS rule in July – The performance threshold is doubling to 30, and the exceptional performance threshold is increasing to 80 points. In isolation these two factors wouldn’t cause consternation. However, toughening requirements in Quality and Promoting Interoperability, the increase weight of MIPS Cost and rising measure benchmarks (more than 60% increased from 2017 to 2018), require healthcare organizations to put a finer point on their MIPS strategy to protect their high scores.

SA Ignite summarized the key changes in the proposed rule and explained why MIPS scores will decrease by 12%-16% in our blog on MIPS Score Erosion.

2. MIPS is structured and predictable, and it intersects with other VBC programs

The strengthening MIPS rules from 2017 into 2019 shows the steady forward progress by CMS to “create a value-based healthcare system for the 21st century”, to quote Alex Azar, HHS Secretary.

The healthcare industry has also turned the corner to support MIPS – 91% of MIPS eligible clinicians participated in 2017. Leaders from respected healthcare associations and alliances including the AMA, American College of Surgeons, America’s Physicians Groups, AMGA and specialty organizations are now actively supporting stronger and more expansive MIPS regulations with recommendations to incorporate more incentives and programs for specialists. This support was articulated in testimony to the United States Congress and formal letters to CMS Administrator, Seema Verma.

Furthermore, additional initiatives are underway to align with MIPS including, CMS Meaningful Measures which is designed to align measures across programs, and the Core Quality Measure Collaborative which is designed to harmonize measures across commercial and government programs.

SA Ignite explored the intersection of MIPS with other VBC programs and found that 25 out of 31 ACO measures are in the MIPS measure set; 14 of the CPC+ quality measures are MIPS eCQMs; and 22 out of 52 HEDIS physician measures share NQF numbers with MIPS quality. In addition to the overlapping quality measures, data collection methods and expectations for CEHRT overlap, and there are similarities in cost measurement. Get the details in our April ABCs of the QPP webinar, MIPS as Spring Training for Value-Based Care.

As value-based care programs become more aligned, healthcare organizations have an increased opportunity to use MIPS as a catalyst to drive change across all clinicians to achieve longer-term, broader VBC goals. Specialists are a key contributor to broader VBC goals, and increasingly to MIPS.

3. More money proposed for exceptional performers in 2019

The proposed maximum incentive payments for 2019 will increase more than 185% from 2% to 5.7%. In addition, the exceptional performance threshold is increasing to 80 points. Healthcare providers who earn MIPS scores >80 will receive maximum incentives as exceptional performers.

To stay revenue neutral and to keep clinicians engaged in the MIPS program, CMS is making it harder to be an exceptional performer and is expanding the number of eligible clinicians. Healthcare organizations will need to take a strategic look at their clinician population and determine which measures will reinforce the MIPS score and which combination of measures and clinicians will yield the biggest boost to keep scores above 80 points.   

Many healthcare organizations see the value of training their MIPS Warriors today, not only to be one step ahead for 2019 but to establish the discipline and rigor to be successful in broader, longer-term value-based care programs. Specialists can play a strategic role by showing performance improvement on measures with lower benchmarks.

SA Ignite helps healthcare organizations of all types maximize their MIPS performance with our IgniteMIPS software and services. Learn how our customers are making MIPS a change enabler in this Healthcare Playbook.

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