Post-SGR Payment Policy: MIPS

October 2016 - Vol. 35, No. 9

MIPS_PieChartThe Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was signed into law April 16, 2015.

MACRA replaced the Sustainable Growth Rate (SGR) and created the Merit-based Incentive Payment System (MIPS) and the Alternative Payment Model (APM) program.

Under MIPS, eligible clinicians (ECs) will report on four categories that will add up to a composite performance score. The composite performance score will be used by CMS to determine whether or not an EC will receive a bonus pay­ment or will be subject to a payment reduction. CY 2019 payment adjustments will be based on CY 2017 reporting.

25% of the total score in 2019
  • Replaces the Medicare Electronic Health Record (EHR) Incentive Pro­gram for clinicians.
  • In the future, Academy Members participating in Regent℠ will be able to report ACI through Regent.
Resource_Use2 RESOURCE USE
10% of the total score in 2019
  • Replaces the cost component of the Value-Based Payment Modifier (VM) Program.
  • The score is based on Medicare claims, meaning no direct reporting requirements for clinicians.
Quality2 QUALITY
50% of the total score in 2019
  • Replaces the Physician Quality Reporting System and the quality component of VM.
  • Physicians select 6 measures to report (including 1 outcome/high priority measure, and 1 cross-cutting measure).
15% of the total score in 2019
  • Clinicians select from a list of over 90 ac­tivities to receive credit for this category.
  • Can report for CPIA through a qualified registry, an EHR system, a QCDR such as Regent℠, or the CMS web interface and attestation data submission.

We have established Regent℠, a qualified clinical data registry (QCDR), which will:

  • Help Members navigate evolving payment models and quality programs
  • Focus on longitudinal perspective of clinical care
  • Inform healthcare at a national level through clinical research
  • Assist with satisfying Maintenance of Certification needs for Members
  • House measures across all specialties of otolaryngology-head and neck surgery

To learn more visit, www.entnet.org/content/alternative-payment-models.

Download a pdf of “Post-SGR Payment Policy: MIPS.”