Introduction to the 4 MIPS Categories for Scoring

This post is part of our series of Afoundria’s MIPS Education Series to help our PAC users position themselves for success under Medicare’s new payment structure.

Your MIPS score will be comprised of 4 main categories. We will be diving into each of these categories in the posts to come with a detailed analysis and directions on how you can maximize your score. In 2017, the total points awarded for each category are as follows:

  • Quality - 60 Points Available
  • Cost - 0 Points Available
  • Advancing Care Information - 25 Points Available
  • Practice Improvement - 15 Points Available

Quality

The Quality Category is very similar to PQRS reporting of years past. While the focus in the beginning will be procedural, as MIPS evolves, scoring will be based on actual clinical quality outcomes. In 2017, this category represents 60 out of the total 100 points available. This is the easiest category to capture the 3 points required to avoid the penalty. For example, merely billing one G-Code per provider in your practice will ensure that every provider meets the minimum scoring threshold to avoid a penalty in 2019! With this strategy, you don’t even need a CEHRT certified EMR to meet the minimum scoring threshold. If you are pushing for a high MIPS score in 2017, quality is the best category to focus on because of the 60 available percentage points. An important note, quality can be difficult for the post-acute practice because of the nature of the patients. We recommend focusing on diseases that make sense for your practice. Many providers will look at Diabetes, but this would be difficult for PAC providers given the nature of your practice. We’ll have more information in our deep dive of the Quality Category.

Cost

MIPS will eventually focus on cost and quality, rewarding providers who reach quality targets while managing costs to a reasonable level. The cost category will have no impact on your 2017 scoring, but we believe it is worth the time and effort to understand how this will work and prepare for the upcoming years where cost will play a larger role in MIPS scoring. We will cover these strategies when we dive deeper into the cost category in a future post.

Advancing Care Information (ACI)

ACI is the MIPS equivalent of Meaningful Use. This is where ChartPath is the most relevant for your MIPS scoring effort. For 2017, ACI comprises a total of 25 potential points for your score. This will be our first big deep dive category as it deals 100% with the certified technology requirement for your EHR. As you know, Afoundria is currently undergoing our CEHRT certification testing and we are expecting a September certification date.

An important note: just using CEHRT certified technology is not enough! CEHRT isn’t even part of the score, rather, it’s the data you collect using the CEHRT technology that qualifies you for ACI points on your total score. Another important note, in 2017, it is acceptable to use 2014 CEHRT technology (basically an EMR that is certified under the 2014 standards). Starting in 2018, you technology MUST be certified on the 2015 standards. Afoundria is seeking 2015 certification for ChartPath, so all of our users will be covered. Our competitors, however, are not doing this (not yet at least). Our competitors’ users will be facing a HUGE risk next year. Good thing you’re on ChartPath!

Practice Improvement Practice Improvement is the final category for MIPS and represents 15 percentage points in 2017. These are procedural and operation steps your practice can take to show continuous practice improvement strategies are being implemented practice wide. We’ll be speaking with a number of organizations doing this and highlighting some of the best practices here to help guide you through this category.