CMS publishes final MIPS rule for eligible clinicians

The Centers for Medicare and Medicaid Services on Friday issued its final rule for the Merit-Based Incentive Payment System (MIPS), a new CMS quality payment program that will reward providers for value and outcomes as part of MACRA.

“This is the same ruling that came out on October 14,” when CMS released its final MACRA rule, said a spokesperson for a hospital/health system alliance. “They just had a few minor edits that slowed down the publishing of the rule in the Federal Register.”



The final rule establishes MIPS, a program for certain Medicare-enrolled eligible clinicians, which will make payment adjustments based on performance related to quality, cost and other measures. MIPS-eligible clinicians include physicians, physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, and groups that include such clinicians who bill under Medicare Part B.

According to CMS, MIPS is designed to “consolidate components of three existing programs, the Physician Quality Reporting System (PQRS), the Physician Value-based Payment Modifier (VM), and the Medicare Electronic Health Record (EHR) Incentive Program for Eligible Professionals (EPs), and will continue the focus on quality, cost, and use of certified EHR technology (CEHRT) in a cohesive program that avoids redundancies.”

Under the final rule, Meaningful Use is essentially restructured into a new Advancing Care Information (ACI) performance category as part of MIPS for purposes of calculating payment. The objectives in the ACI performance category of MIPS emphasize measures that support clinical effectiveness, information security and patient safety, patient engagement, as well as health information exchange.

MIPS-eligible clinicians must report the numerator and denominator of certain measures specified for the ACI performance category, which are based on the measures adopted by the EHR Incentive Programs for Stage 3 in the 2015 EHR Incentive Programs Final Rule, which will account for 50 percent (out of a total 100 percent) of the ACI performance category score.

“We are encouraged by CMS’ effort to better align components of the MIPS program and applaud CMS’ first steps in harmonizing ACI measures with improvement activities,” said Andrew W. Gurman, MD, president of the American Medical Association.

“It is important that physicians start to realize a greater return on their EHR investments,” added Gurman. “Physicians should be rewarded when their innovative uses of health IT help to achieve patient goals, rather than just checking more boxes. Ultimately, if CMS continues down this path, we expect far fewer prescriptive measures around the use of health IT, leading to an overall improvement in the design and usefulness of these tools going forward.”

Also See: Is the new MIPS payment system deadline too challenging?

The new ACI performance category score under MIPS defines a meaningful EHR user as a MIPS-eligible clinician who possesses certified EHR technology, uses the functionality of CEHRT, and reports on applicable objectives and measures.

“Full utilization of technology will be critical to the success of both MIPS and Alternative Payment Models, and we look forward to continuing to work with CMS and Congress to identify opportunities where technology can streamline the programs to work better for providers and patients,” said Robert Horne, executive director of Health IT Now, a coalition of providers, patient advocates, consumers, and payers.

The first MIPS performance period is slated to start on Jan. 1, 2017, running the length of the calendar year, with the first MIPS payment year scheduled to begin in 2019. Starting with the performance period in 2018, MIPS-eligible clinicians are required to only use technology certified to the 2015 Edition to meet the ACI objectives and measures.

CMS will accept public comments on the final rule until December 19.