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Physicians should stay the course until new MIPS program takes effect

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WAIKOLOA, Hawaii — Physicians need to “keep running on the treadmill” with regard to existing CMS quality programs, until the new, combined Merit-Based Incentive Payment System begins in 2019, a speaker here said.

Under the Medicare Access and CHIP Authorization Act of 2015, PQRS, Meaningful Use and the Value-Based Payment Modifier programs will be merged into the new MIPS program.

Donna McCune

“If you are suffering any penalties as a result of these existing programs, those will ‘sunset’ after 2018,” Donna McCune, CCS-P, COE, CPMA, told colleagues at Hawaiian Eye in a symposium on the Changing Ophthalmic Practice Environment. Until then, however, physicians should continue to do what they have been doing already with regard to these programs, she said.

According to McCune, under the MIPS program, physicians will receive a composite score based on the three existing programs plus a new program – the Clinical Practice Improvement Activities (CPIA). A score of 0 to 100 will be given based on performance in each of the four categories. A composite score will then be compared with performance threshold to determine bonus vs. penalty vs. no payment adjustment, she said. Additional bonus funds will be available for exceptional performance, she said, although these are not yet defined.

There will be new bonuses and new penalties, according to McCune, with a reimbursement impact for the 2019 payment year of about ± 4% and for the 2022 payment year of about ± 9%.

The CPIA program “is still somewhat subjective,” she said. “We don’t really have a clear definition of what the clinical practice improvement activity category will be. At least with the other programs, we know what goals have to be achieved, what things have to be done in order to be successful.” – by Patricia Nale, ELS

Reference:

McCune D. What you should know about PQRS, VBPM, and MIPS. Presented at: Hawaiian Eye; Jan. 17, 2016; Waikoloa, Hawaii.

Disclosure: McCune reports no relevant financial disclosures.