MIPS and the Business of Healthcare


Post by Vicki Harter, BA, RRT


Vice President, Care Transformation

At this year’s Healthcare Information and Management Systems Society (HIMSS) conference, representatives from the Centers for Medicare & Medicaid Services (CMS) held multiple sessions where they reinforced the message that the Quality Payment Program and value-based programs are moving forward. Jean Moody-Williams, deputy director of the center for clinical standards and quality at CMS said “As we build the program, our goal is to achieve a 90 percent participation rate by all clinicians. That includes small practices as well.”[1] Other CMS officials touted tangible results that value-based care has been delivering, such as a “17 percent reduction in hospital acquired conditions across all measures from 2010 to 2013, to savings of $37 million from providers participating in the advanced ACO Pioneer program.”[2]

As about nine out of ten providers are expected to fall under the Merit-Based Incentive Payment System (MIPS) track of the Medicare Access and CHIP Reauthorization Act (MACRA), many providers are asking themselves whether they should fulfill MIPS’ minimum requirements or strive for more. Said another way, should their organization strive to be a MACRA All-Star? Is it worth it to commit the effort and investment required to max out potential bonuses?

There are four main inputs to consider as you create your data-driven strategy for performing under MIPS. The first is the amount of Part B Reimbursements that you are expecting currently, how much you have received in the past, and how much you expect to receive in the future. That is going to drive your bonus potential as a practicing system, which is the second input to consider. Your bonus potential is going to help you understand the amount of resources that you have available to make the necessary changes in your care team. This third factor is critical in driving your organization’s MIPS strategy as you may decide to change the workflows of your nurses and physicians or add a data analyst to help you take care of the populations that are now transforming your practice. And finally, consider the amount of data analytics you have in your practice. In the past, where have you performed? Where do you stand to gain? How much of a gap do you have to close to become a MACRA All-Star?

Providers should think about these key inputs they will need to evaluate for their MIPS strategy. What is my Medicare Part B Revenue today? What impact does MACRA have on it? Do I need to get ahead of payment rates that will remain basically flat? How many resources will be impacted by MACRA reporting requirements this year, next year, in two years? Can I earn a bonus that makes a difference to my business?

If you’d like to continue the discussion, please send a note here.

[1] http://www.diagnosticimaging.com/articles/cms-seeks-make-macra-manageable-small-practices

[2] http://www.healthcarefinancenews.com/news/despite-some-good-parts-ahip-says-gop-healthcare-bill-concerning-insurers