The 2024 Quality Payment Program (QPP) brings challenges but also opportunities for physician practices and clinical settings. While Merit-Based Incentive Payment System (MIPS) participation can lead to negative payment adjustments for low performance, it can also reward positive outcomes with financial benefits, as demonstrated by Baptist Health Care's experience.
The following article offers a traditional MIPS program overview as well as what eligible clinicians should know about the QPP in CY 2024. With the right tools, preparation, and partnership, MIPS participation can empower healthcare providers and organizations to enhance their care quality and financial performance.
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Despite the positive changes it has brought about in healthcare, the Merit-based Incentive Payment System (MIPS) under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) has been criticized for its complexity and potential burden on smaller practices. However, there are ongoing efforts to address these concerns and improve the program to ensure that it continues to enhance the quality and efficiency of healthcare.
This value-based system emphasizes the importance of delivering high-quality healthcare and encourages medical professionals to prioritize better patient outcomes. As a result, healthcare institutions are increasingly relying on data and healthcare analytics to make informed decisions and ensure continuous improvement in patient outcomes.
Indeed, the program has encouraged providers to adopt electronic health records and other advanced technologies to make patient care more efficient, improve communication among care teams, and ultimately enhance health outcomes. Furthermore, MIPS encourages continuous improvement in medical practices by establishing annual performance targets that challenge professionals to achieve higher levels of patient satisfaction and overall quality of care.
Through a complex scoring system, MIPS assesses healthcare professionals or groups based on four performance categories:
Below are additional details providers should know about MIPS.
The traditional MIPS reporting option has been available since the first year of the Quality Payment Program (QPP). Under this option, participants are required to select the quality measures and improvement activities they will collect and report. These measures are chosen from all the quality measures and improvement activities that have been finalized for MIPS.
Additionally, participants must report the complete Promoting Interoperability measure set. It's worth noting that the Cost category does not require separate data submission as it is based on Medicare claims and is collected by the Centers for Medicare & Medicaid (CMS).
Understanding the performance threshold is crucial for healthcare providers participating in MIPS. Acknowledging this threshold as a barometer of quality and efficiency, providers can proactively work towards achieving positive payment adjustments while elevating their overall standard of care.
Providers participating in the MIPS program are evaluated based on a final score that ranges from 0 to 100 points. To avoid a negative payment adjustment to Medicare Part B-covered professional services resulting from the CY 2024 performance period, providers must strive for a performance threshold of 75 points. A score below 75 points not only results in a negative adjustment but also signifies potential areas for improvement within their practice.
The standard category weights for each performance category will remain unchanged for the performance year 2024. They include:
CMS uses the MIPS score to compare the performance of a provider or group against the MIPS performance threshold. Based on this comparison, CMS decides whether the participant should receive a positive, negative, or neutral payment adjustment. Additionally, for the 2024 performance year, CMS has finalized an inventory of 198 traditional MIPS quality measures.
This update includes:
• The addition of 11 MIPS quality measures, which include one composite measure and six high-priority measures, out of which four are patient-reported outcome measures.
• Significant changes to 59 existing MIPS quality measures. The removal of 11 MIPS quality measures and partial removal of three MIPS quality measures which were removed from the traditional MIPS and retained for MVP Value Pathways (MVP) use only. MVPs are the future of reporting for MIPS.
To succeed in the MIPS program, it's essential to ensure the accuracy of data and reporting. Being proactive can help avoid penalties and enhance care quality, leading to higher incentive payments. Providers can improve MIPS scores by using monitoring and reporting tools that provide comprehensive and precise data and analytics.
Baptist Health Care implemented Health Catalyst’s MeasureAbleTM – a quality measures solution that combines complete data, measures, visualizations, and workflows (measurement, improvement, and submission) into one comprehensive system. The application calculates performance, offers a performance dashboard, and includes a submission engine that submits data directly to CMS.
The adoption of the MeasureAble™ application enabled Baptist to accurately measure its performance, resulting in an increase of its composite MIPS score to 92.94.
Healthcare providers who want to meet MIPS standards should not only adopt appropriate technology but also consult trustworthy sources and official regulatory documentation to stay up to date with the latest information. They should also check their eligibility for the Quality Payment Program and thoroughly review the specific improvement activities and requirements that apply to each category under the MIPS program.
Would you like to learn more about this topic? Here are three articles we suggest:
A Complete Guide to MIPS Quality Measures
Data-Informed MIPS Improvement Efforts Drive Improved Quality Scores and Increased Revenue
