MHA FPX 5068 Assessment 1 Merit-Based Incentives and Daily Operations MHA-FPX 5068 Leadership, Management and Meaningful Use of Health Care Technology ​​​​​​​Merit-Based Incentives and How they Affect Daily Operations

MHA FPX 5068 Assessment 1 Merit-Based Incentives and Daily Operations

MHA-FPX 5068 Leadership, Management and Meaningful Use of Health Care Technology

Merit-Based Incentives and How they Affect Daily Operations

The Merit-Based Incentive Program System (MIPS) was established under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) to transition the healthcare industry from fee-for-service to value-based payment models. Effective since January 2017, MIPS determines Medicare payment adjustments based on a composite performance score. Eligible clinicians may receive payment bonuses, penalties, or no adjustments based on their final MIPS score (Centers for Medicare and Medicaid Services [CMS], 2021). The MIPS score comprises four performance categories: quality, improvement activities, promoting interoperability, and cost, which are calculated by CMS using measures and activities reported by organizations (Berdahl et al., 2019).

Consolidating previous quality reporting programs, MIPS aims to reduce financial penalties for physicians and increase potential bonus payments (Rathi, 2019). However, challenges such as the lack of incentives for providers in fee-for-service models and difficulties in aligning stakeholders persist. Simplification of quality measures across reimbursement programs could alleviate these challenges (Eggleton, Liaw, & Bazemore, 2017).

To benefit beneficiaries, quality data must be presented in a user-friendly format, yet challenges with documentation standards hinder alignment among payers and providers (Berdahl et al., 2019; Johnson et al., 2020). Collaboration between organizations, payers, providers, and quality measurement professionals is essential to mitigate these challenges (Berdahl et al., 2019).

Exclusions from MIPS eligibility include participation in Alternative Payment Models (APMs), low Medicare beneficiary volume, and providers new to Medicare. Meeting MIPS measures requires selecting appropriate measures aligned with organizational strengths, investing in MIPS technology, and educating clinicians (Eggleton et al., 2017; Rutherford, 2017).

Failing to meet MIPS measures incurs penalties and impacts reimbursement rates. Participating in MIPS offers incentives for performance improvement, whereas non-participation leads to lower reimbursement rates and missed bonus opportunities (Berdahl et al., 2019; Khullar et al., 2021).

Conclusion

Management strategies should focus on improving MIPS performance by educating clinicians, integrating MIPS requirements into workflows, ensuring accurate clinical documentation, and appointing MIPS champions. These efforts safeguard financial stability and enhance patient care quality.

References

Berdahl, C. T., Easterlin, M. C., Ryan, G., Needleman, J., & Nuckols, T. K. (2019). Prminay care physicians in the merit-based incentive payment system (MIPS): A qualitative investigation of participants’ experiences, self-reported practice changes, and suggestions for programm administrators. Journal of General Internal Medicine: JGIM, 34(10), 2275-2281. https://doi.org/10.1007/s11606-019-05207-z

Centers of Medicare and Medicaid Serivces (CMS) (2021). Physician Quality Reporting System (PQRS) overview- CMS.gov. https://www.cms.gov/medicare/quality-initiatives-patient-assessmentinstruments/PQRS/downloads/PQRS_overviewfactsheet