Merit-Based Incentive Pay

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CMS Quality Measure Development Plan Changes

As one of the changes coming from the 2015 MACRA legislation, MIPS consolidates the incentive programs for Meaningful Use, Physician Quality Reporting System and Value Modifier Payments, and synchronizes the Clinical Quality Measures across these programs. Reporting meaningful use and quality measures will remain an ongoing requirement to avoid negative payment adjustments in future years, and the Value Modifier is already in effect this year for practices of 10 or more Eligible Providers, expanding to all providers in 2017.

MIPS will assign a composite score derived from measures across 4 categories:

Quality Measures from CQM reporting (PQRS)
Resource Utilization scored on Expected vs Actual costs, adjusted for Risk
Clinical Improvement Activities
Meaningful Use continuing attestation

PQRS requires annual reporting of Clinical Quality Measures, and applies an automatic negative payment adjustment of -2% to Eligible Providers that do not submit CQMs. The payment adjustment is applied in the second calendar year, so 2016 adjustments reflect 2014 reporting.

Value Modifier adjustments currently start with participation in the PQRS program, with an automatic 2% negative adjustment for non-participation (on top of the PQRS negative pay adjustment), and quality-tiering of participating providers to allocate the incentive funds with positive and negative pay adjustments based on quality and cost measures. Only groups of 100 or more EPs can receive a negative pay adjustment in 2016; groups of 10-99 EPs can only receive positive or neutral adjustments until 2017.

MIPS will apply pay adjustments starting in 2019 that are upward or downward from expected payments a maximum of 4% and increasing to 9% by 2022, based on the combined factors listed above. Payment adjustments are budget-neutral, which means that providers who gain incentives are offset by an equal amount of providers that get a negative adjustment.

​​​Merit-Based Incentive Pay System

Merit-Based Incentive Pay System