MIPS rule proposes changes to quality reporting starting in 2017

Providers will have fewer quality measures to report and potentially higher bonuses if CMS finalizes proposals in the Merit-based Incentive Payment (MIPS) rule released April 27.

Providers would have to report six measures, as opposed to the nine now required by the Physician Quality Reporting System (PQRS), according to the proposed rule. National quality strategy domains will become a thing of the past.

The maximum bonus or pay cut for providers who take part in MIPS would equal 4% of their payments, with qualified advanced payment model participants eligible for a lump-sum bonus of up to 5%. MIPS participants who do go above and beyond in their quality performance could receive an additional performance payment on top of the 4% bonus.

The MIPS proposed rule is the first significant regulation tied to the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, which remapped physician reimbursement in both the near- and long-term and propelled CMS to revise its quality-reporting programs (PBN 4/20/15).

Highlights of the MIPS proposed rule include:

• Claims-based reporting will stay. Don’t worry that you’ll be forced to move to a new reporting platform next year. Providers who participate in MIPS will be able to report via claims, registries, electronic health records and the CMS web interface.

• CMS also plans to broaden the program to include non-Medicare payers. In the first two years, the program will be focused on traditional fee for service Medicare, said Patrick Conway, M.D., CMS principal deputy administrator and chief medical officer, during an April 27 press call. But starting with reporting year 2019, for payment adjustments in 2021, the MACRA law allows the agency to include all payer data. It could include Medicare Advantage, Medicaid and commercial health plan quality data.

• PQRS and meaningful use are not going away entirely until 2018. “We are not proposing to delete these regulations entirely, as the final payment adjustments under these programs will not occur until the end of 2018,” says the rule.

• Electronic health record (EHR) surveillance. The rule takes a broad interest in your use of EHR in general. Providers must attest “that they have cooperated with the surveillance of certified EHR technology under the ONC Health IT Certification Program” and “must demonstrate [their] cooperation with these authorized surveillance and oversight activities.” They are also required to demonstrate that they have not “knowingly and willfully taken action (such as to disable functionality) to limit or restrict the compatibility or interoperability of certified EHR technology.”

This is a developing story. Stay tuned to Part B News, Medical Practice Compliance Alert, Medical Practice Coding Pro and your Pink Sheets for anesthesia and pain, cardiology and orthopedics.