The Merit based Incentive Payment System (MIPS), established by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), came into effect on January 1, 2017. It is a major catalyst towards transforming the healthcare industry from fee-for-service to pay-for-value. MIPS rolled 3 existing quality and value reporting programs (PQRS, VBM and MU) into one points based program. MIPS annually scores eligible Medicare Part B clinicians on a 100-point performance scale which results in a Composite Performance Score (CPS). The payment adjustment will be based on this Composite Performance Score which is calculated by the measures and categories reported. MIPS is designed to be a budget-neutral program, but there is $500 million allocated to provide additional incentive to exceptional performers- those earning 85 or more points in 2021. The Quality Payment Program (QPP) consists of two major tracks: The Merit-based Incentive Payment System (MIPS)
Alternative Payment Models (APMs)
Most providers will initially participate through MIPS.
The 4 scorable MIPS categories in 2021 are:
Quality (40% of score)
Promoting Interoperability (25% of score)
Improvement Activities (15% of score)
Cost (20% of score)