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PQRS vs. MIPS: The Major Program Differences Explained [with Bonus Charts]

If your practice has become accustomed to participating in PQRS, you may be wondering exactly how MIPS will affect you. Under the new Quality Payment Program, the updates to Medicare quality reporting are significant, but still incorporate some of the characteristics of PQRS that practices are familiar with.

In this article, we’ve broken down the basic differences between PQRS and MIPS for the 2017 reporting year to help you understand CMS’ changes and prepare for future reporting success.

Key Program Differences

Who Participates?

MIPS most likely applies to you in the first year if you are a physician (MD/DO and DMD/DDS), PA, NP, clinical nurse specialist or a certified registered nurse anesthetist not participating in an Advanced Alternative Payment Model (APM).

What is the Small Practice Exemption?

MIPS will not apply to you if you treat fewer than or equal to 100 Medicare beneficiaries or have less than or equal to $30,000 in Medicare charges.

How Will GPRO Work?

You no longer need to register in advance to report as a group (formerly known as the Group Practice Reporting Option (GPRO), unless you are submitting via the CMS Web-Interface. Under Meaningful Use (MU), there was no option to report as a group, but now providers have that choice. However, if you choose to report as a group in one MIPS category, you must report as a group in all categories.

How is Registry Involvement Impacted?

Registries can now submit for the three performance categories of MIPS (Quality, Advancing Care Information and Improvement Activities). Also new for the Quality category, registries can now submit the EHR measures. Prior to MIPS, EHR measures could only be reported via EHR direct, a Data Submission Vendor or QCDR.

How is the Final Score Determined?

Under MIPS you will receive points in four weighted performance categories that will add up to be your Final Score. How your Final Score compares to the threshold score set by CMS each year will determine if you receive an incentive or a penalty.

In 2017, each performance category will be weighted as follows:

MIPS’ 4 Weighted Performance Categories

Quality

The Quality category accounts for 60% of your Final Score in 2017. This category replaces PQRS and CMS-calculated measures under the Value Modifier (VM).

Resource Use (Cost)

This category will not count for 2017, but it will count in future years of MIPS and is scheduled to account for 30% of your Final Score by 2019. In this category, CMS will examine claims data to determine the cost of caring for patients attributed to the practice.

Improvement Activities

This category accounts for 15% of your Final Score in 2017. Practices that focus on improvement efforts will be rewarded. These improvement efforts can include:

  • Care coordination
  • Beneficiary engagement
  • Patient safety
  • Extended hours
Advancing Care Information

This category replaces the Medicare Electronic Health Record (EHR) Incentive Program for eligible professionals – also known as Meaningful Use (MU). It will account for 25% of your Final Score in 2017. Note: Hospital and Medicaid Meaningful Use are continued.

For a better understanding of how the future of Medicare reporting will compare to the reporting structure of the past, we have created the following PQRS and MIPS comparison charts:

PQRS vs. MIPS Reporting Requirements

 

2016 Reporting 2017 Reporting
PQRS, Value Modifier (VM) and Meaningful Use (MU) MIPS and the Quality Payment Program
Program Requirements Category Requirements
PQRS 9 measures, 3 domains and 1 cross-cutting measure.

Reporting period is a full year of data or a Measure Group. Includes Medicare Part B only.

CAHPS was required for groups of 100 or more.

Quality 6 Measures and 1 outcome measure.

No Measure Groups.

Domains no longer count.

No cross-cutting measure.

CAHPS not required.

Bonus points for additional high-priority measures.

Reporting period is 90 days for all payers.

1 CMS-calculated Quality Measure: All-Cause Hospital Readmission

Value Modifier (VM) Report PQRS for 50% of providers or receive a penalty.
Quality Tiering PQRS data and CMS-calculated Quality and Cost measures used for incentive and penalties.

3 CMS-calculated quality measures and 6 CMS-calculated cost measures.

Cost (Resource Use) Does not count for 2017.
Medicare EHR Incentive Program (Meaningful Use/MU) 10 objectives including core measures, menu measures, and eCQMs. Advancing Care Information Includes base score measures and performance measures.

Bonus points for Improvement activities using CEHRT.

No separate requirement for eCQMs.

  NEW Improvement Activities Providers receive credit for activities they are already doing to improve their practice.

Those who have qualified for Patient-Centered Medical Homes receive full credit immediately.

 

Reporting Deadlines

 

2016
PQRS, VM and MU

2017
MIPS and Quality Payment Program
Reporting Deadline Multiple reporting deadlines March 31, 2018
Payment Adjustments Applied Multiple adjustments based on particular program A single adjustment for all performance categories

 

Program Scoring

 

PQRS, VM and MU 2017 MIPS Reporting Year
Program Scoring Category Scoring
PQRS First level scoring was pass/fail. Quality Scoring is measured on a scale of 3-10 points per measure.
Value Modifier Under VM, providers and practices were scored on cost, based on Medicare claims data and quality, based on PQRS measures. Cost (Resource Use) This category will not count for the 2017 reporting year.
Meaningful Use MU scoring was pass/fail. Advancing Care Information There are 4-5 questions for the base score you must pass.

You receive points for each performance measure above the base score.

NEW   Improvement Activities In the 2017 “transition year” you need just 40 points to receive full credit.

Download your copy of the charts now!

Ready to Succeed with MIPS?

It’s important to remember that the first year of MIPS is a transition year. You will only need to earn three points to avoid a penalty, and it will be easy to earn a small incentive.

Practices can adjust to the transition from PQRS to MIPS by:

The changes to Medicare quality reporting are significant, but we’re here to help you navigate MIPS and prepare for the future of the new Quality Payment Program. Contact us today and we’ll address your questions and concerns.

 

 

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