The Difference Between MIPS 2017 vs MIPS 2018

By Erin Heilman. Posted Jan 19, 2018 in Quality Reporting, MACRA/MIPS Program, Academy

The beginning of the year can be a tricky period for those responsible for overseeing the smooth execution of their Quality program. At this point in the year you may not yet have submitted your files to successfully meet your 2017 MIPS requirements, but the new year has started, and with it, the need to start monitoring and capturing your results for your 2018 MIPS reporting year.

During this time we thought it would be helpful to clearly lay out the differences in the MIPS program between 2017 and 2018. This way, while you are preparing to submit your required MIPS files (MARCH 31 DEADLINE), you can keep in mind the measures you should be tracking and monitoring in 2018.

Let's review how the MIPS program changes or stays the same in 2018.

PAYMENTS


2017


2018

-4% / +4%

Eligible Clinicians can lose -4% if you do not achieve the score threshold of the MIPS program or gain up to 4% for excellent performance.

-5% / +5%

Eligible Clinicians can lose -5% if you do not achieve the score threshold of the MIPS program or gain up to 5% for excellent performance.

 

Note: This payment adjustment will be made to your fiscal year 2019 and 2020 Medicare fee schedule respectively.

Score threshold requirements

In 2017, all clinicians really have to do is the bare minimum (submit one measure with information for one day) and they will score three points and avoid a penalty. In 2018, you must actually do a little bit more work to achieve the 15-point threshold.


2017


2018

Must achieve a score of 
3 points
to avoid a penalty.

MIPS_Budget_Neutral_Graphic-Updated-1.png

Must achieve a score of 
15 points
to avoid a penalty.

MIPS_Budget_Neutral_Graphic-Updated-2018.png

 

By scoring at least 70 points in either 2017 or 2018, you’ll be eligible for the Exceptional Performance bonus money. CMS has set aside an additional $500 million to distribute to anyone who scores between 70 – 100 points (see far right). This is on top of whatever portion of money you receive from those who do not meet the threshold (in red).

CATEGORY REQUIREMENTS

There are four categories that make up the MIPS program.

Quality.png  Category-Icons-02.png  Category-Icons-03.png  Cost.png

Quality

(Formerly the PQRS program)  

Advancing Care Information
(Formerly the 
Meaningful Use program) 

Improvement Activities

(New program)      

Cost

(Formerly the 
Value-Based Modifier program)

Each of these categories carries a different weight. Your score in each category will be totaled into one composite MIPS score. The weight that each category carries differs between 2017 and 2018. 


2017


2018

Category-Weight.png

Category-Weights-2.png

 For the first time in 2018, your Cost performance will factor into your total MIPS score. To balance the total score, they reduced the weight of the Quality category to 50%.

QUALITY CATEGORY


2017


2018

Maximum Points: 60 points
Category is Worth: 60% of total MIPS score
Performance Period: 90-365 days

Requirements

  • Report a total of six Quality measures to CMS.
  • Submit at least one Outcome measure.
  • Submit 90-365 days’ worth of 2017 data.

Maximum Points: 60 points
Category is Worth: 50% of total MIPS score
Performance Period: 365 days

Requirements

  • Report a total of six Quality measures to CMS.
  • Submit at least one Outcome measure.
  • Submit 365 days’ worth of 2018 data.

 

Data Completeness


2017


2018

50%

Submitted Quality measures must contain at least 50% of all Eligible Clinician patients across all payers.

60%

Submitted Quality measures must contain at least 60% of all Eligible Clinician patients across all payers.

 

ADVANCING CARE INFORMATION CATEGORY


2017


2018

Maximum Points: 155 possible points, but capped at 100 points
Category is Worth: 25% of total MIPS score
Performance Period: 90 days (minimum)

Requirements

  • Report all four Base measures 
  • Choose from seven Performance measures and submit enough to reach the 100-point threshold.
NO CHANGE

 

Note: If you have achieved Meaningful Use Stage 3 Functionality and have the 2015 EHR Certification you may choose to submit the advanced Base measure set instead.

Improvement Activities CATEGORY


2017


2018

Maximum Points: 40 points
Category is Worth: 15% of total MIPS score
Performance Period: 90 days (minimum)

Requirements

  • Report a combination of Improvement Activity measures (up to 4 measures) to equal a total of 40 points.
  • Groups with <15 participants in a rural or health professional shortage area may attest to 2 Improvement Activities for 90 days (minimum).
NO CHANGE

 

Note: If you are Patient-Centered Medical Home and more than 50% of your practices are recognized as a PCMH, you automatically receive full credit for this category.

Cost CATEGORY


2017


2018

Maximum Points: 0 points
Category is Worth: 0% of total MIPS score
Performance Period: 0 days

Requirements

  • No requirements.

Maximum Points: Unknown
Category is Worth: 10% of total MIPS score
Performance Period: 365 days

Requirements

  • No additional submission is required. CMS will evaluate Eligible Clinicians based upon only their 

    Medicare Spending per Beneficiary (MSPB) and Total Per Capita Cost measures in 2018 to calculate their Cost score.

 

Reporting Options

In 2017, you could "Pick Your Pace" for reporting to CMS. In fact, it takes very little effort to simply avoid the penalty. Alternatively, you could fully participate in 2017 and if you do so, you will be much more prepared to handle the requirements of 2018. In this year, there is no option for going at your own pace. You must attempt to fulfill all of the requirements and based upon your performance, you will receive a total MIPS score that will ultimately give you a pay increase or decrease. 


2017


2018

Pick Your Pace

MIPS_Levels_Of_Participation.png

Quality.png

Quality

  • Report a total of six Quality measures to CMS.
  • Submit at least one Outcome measure.
  • Submit 365 days’ worth of 2018 data.

Category-Icons-03.pngImprovement Activities

  • Report a combination of Improvement Activity measures (up to 4 measures) to equal a total of 40 points.
  • Submit 90 days' worth of 2018 data.Category-Icons-02.png

Advancing Care Information

  • Report all four Base measures 
  • Choose from seven Performance measures and submit enough to reach the 100-point threshold.
  • Submit 90 days' worth of 2018 data.

Cost.png

Cost

    • Medicare Spending per Beneficiary (MSPB)
    • Total Per Capita 
  • Calculated for 365 days’ worth of 2018 data.

 

Whether you are all wrapped up for your 2017 reporting or are still scrambling to figure out what you need to do, take the time now to ensure your organization has a good plan in place. Identify all of the players and stay in regular communication about goals and timelines. Find your vendor (like Medisolv) who will help you with your performance improvement in addition to submitting your files. The only way to have a comprehensive Quality program in place is to ensure every detail is thought through. The beginning of the year is a good time to clear your head, put new processes in place and start fresh.


DOWNLOADS:

MACRA Guide

Beginner's Guide to MACRA (2017)

MACRA Guide

Beginner's Guide to MIPS Year 2 (2018)


WEBINAR:

Wednesday, October 24, 2018
1 p.m. ET | 12 p.m. CT | 10 a.m. PT

QUALITY REPORTING: 2018 AND BEYOND

Tying payments to performance across quality and cost dimensions requires robust measurement and reporting. Hospitals and providers, however, are demanding relief from regulatory burdens including quality reporting. What gives?

In response to both internal needs and external pressures, CMS continues to propose dramatic changes in its Quality Reporting programs. While this session will primarily focus on these hospital and ambulatory changes for quality reporting in 2018, future reporting trends and lessons applicable across the continuum of care will also be discussed. In addition, we’ll share some strategies that will help you to better manage multiple measure types for the major regulatory reporting programs.

Objectives

  • Review 2018 reporting requirements and discuss future trends in quality reporting. 
  • Gain insight into what quality reporting is likely to look like beyond 2018. 
  • Learn strategies to help you stay on top of the complex and changing reporting requirements year after year.


Speaker info:
Dr. Zahid Butt, MD, FACG
Medisolv, President & Chief Executive Officer

Register Now

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Erin Heilman

Erin Heilman

Erin Heilman is the Marketing Director for Medisolv, Inc.

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