Health IT, Policy

Medicare ‘doc fix’ making things complicated with MIPS

Tom Lee, founder and CEO of SA Ignite, discusses why the new Medicare Merit-based Incentive Payment System, or MIPS, could be an administrative headache for medical practices and a boon for his company.

Physician organizations were mostly thrilled when Congress passed the “doc fix” legislation in April, replacing the despised Medicare Sustainable Growth Rate with the Merit-based Incentive Payment System, or MIPS. Now, things are getting, um, fun.

“MIPS is making everything more complicated,” said Tom Lee, founder and CEO of SA Ignite, a provider of cloud-based back-office automation for healthcare providers in pay-for-performance reimbursement programs. Lee has called his Chicago-based company the TurboTax for Meaningful Use.

And it doesn’t even kick in until 2017.

For federal fiscal year 2016, which started Oct. 1, CMS started employing a value-based payment modifier for the Physician Quality Reporting System (PQRS). With this calculation, CMS now can adjust Medicare Part B payments up or down by as much as 4 percent. “PQRS is no longer pay-for-reporting,” Lee said.

SA Ignite made its hay automating attestation for the Meaningful Use electronic health records incentive program. Lee said that the PQRS value-based modifier and MIPS are far more complicated than Meaningful Use, creating another business opportunity; SA Ignite has become the top listing on a Google search of “merit-based incentive payment system.”

MIPS consolidates PQRS, the value-based modifier and Meaningful Use programs, and will affect about 30 percent of Medicare Part B payments. “With MIPS, there are winners and losers,” Lee said.

Value-based care makes up 30 percent of MIPS calculations.

Providers in Medicare Shared Savings Program Accountable Care Organizations are exempt from MIPS if they meet certain revenue thresholds. In 2017, Part B bifurcates, so providers must choose either MIPS or an ACO-type alternative payment model.

Under PQRS, and presumably with MIPS in the future, “CMS doesn’t tell you what your performance score is until nine months after the reporting period,” Lee said. SA Ignite has automated the rules, trying to predict that score so the practice can adjust before it’s too late.

There are different methods of PQRS reporting. “Sometimes your quality score can change drastically depending on the method the provider chooses,” Lee said. “It’s like if you filed your taxes with a bad accountant vs. a good one.”

Photo: Flickr user Peasap

 

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