0% MIPS HOW DR. BARBARA WHITLEY COMES TO GRIPS WITH 2017 IS THE FIRST MIPS REPORTING YEAR. The goal of this new quality program is to streamline reporting to CMS and improve care. But a tangle of evolving rules is giving clinicians a headache. 1 HER MONEY IS ON THE LINE Dr. Whitley will receive Medicare payment adjustments beginning in 2019 based on how far off she is from the performance benchmark (which CMS sets yearly). STAY TUNED T0 ATHENAINSIGHT.COM TO FIND OUT HOW DR. BARBARA WHITLEY PERFORMS ON THE FOUR MIPS CATEGORIES QUALITY COST CARE COORDINATION (called "Improvement Activities") EHR USE (called "Advancing Care Information") BAD NEWS: Not participating at all will result in an automatic -4% payment adjustment in 2019. MEET DR. BARBARA WHITLEY A family practice physician, she sees 863 patients per year, 18% of them on Medicare. Let’s see how this fictional, average clinician navigates her first MIPS year. GET READY: MIPS IS GOING TO DISRUPT DR. WHITLEY’S PRACTICE, BUT IT MATTERS FOR TWO REASONS: GET SET… MIPS HAS FOUR CATEGORIES THAT WILL DETERMINE DR. WHITLEY’S SCORE AND REVENUE. GO! DURING 2017, DR. WHITLEY HAS FOUR OPTIONS FOR PARTICIPATING IN MIPS. OPTION For a partial year— 90 consecutive days of her choice (DEADLINE IS OCT. 1) Neutral or potentially positive SUBMIT: ADJUSTMENT: For a full year starting Jan. 1 Neutral or potentially positive SUBMIT: ADJUSTMENT: Something Neutral SUBMIT: ADJUSTMENT: Nothing -4% SUBMIT: ADJUSTMENT: Dr. Whitley missed the deadline (Jan. 1) for full-year reporting. She chooses OPTION 3 . But she wants to start early: If she tries for 90 days and under-performs, she can course-correct and try another 90 days. GOOD NEWS: 2017 is a “transition year” for MIPS, giving clinicians some flexibility in reporting and performance. 60 50 30 2017 2018 2019 CATEGORY WEIGHT CHANGES OVER TIME 30 15 25 10 15 25 15 25 NOTE: Cost is unweighted in 2017, though CMS will provide assessments for future performance reference. SCORE (POINTS) 2017 MIPS SCORE PAYMENT ADJUSTMENTS – TRANSITION YEAR FULL NEGATIVE ADJUSTMENT NEUTRAL ADJUSTMENT +4% 0 3 4–70 70–100 NOTE: In future years, providers will need to score more than 3 points in order to avoid a negative adjustment. NOTE: It is possible to achieve an exceptional bonus above +4%. SOME POSITIVE ADJUSTMENT -4% MAXIMUM POSITIVE ADJUSTMENT 2 HER REPUTATION IS ON THE LINE From now on, Dr. Whitley’s performance data will be available to the public through the Medicare.gov Physician Compare website. 3 OPTION 4 OPTION 2 OPTION 1 PAYMENT ADJUSTMENT INFORMATION CURRENT AS OF THE OCTOBER 2016 RULING. 2017 YEAR 2017 ©2017athenahealth, Inc.