Reflecting on the QPP MIPS 2021 Reporting Requirements

Merit-Based Incentive Payment System or MIPS is a way to participate in the Quality Payment Program (QPP). It replaced three older programs (PQRS, VBM, and MU) and formed a system with categories, which MIPS Qualified Registries report for on behalf of the physicians.

These categories hold certain weights and come together to give a score known as the MIPS composite or final score under MIPS 2021 reporting.

Purpose

The program determines payment adjustments for Medicare part B workers, and as stated above, it depends upon their MIPS score.

Scoring

In MIPS 2021 reporting, clinicians need to report mainly on factors like

• The quality of care they provide their patients
• The cost of their services
• Improvements in their services and patient interactions
• Certified Electronic Health Record Technology (CEHRT) to exchange medical information

Each of these factors gets points per their weightage, and then it is all added up to make the MIPS composite score. It can range from 0 to 100 points.

Also, the final score determines if the clinician’s payment adjustment is negative, positive, or neutral.

Reporting Frameworks

There are three MIPS 2021 reporting frameworks, which are

• Traditional MIPS
• Alternative Payment Model (APM) Performance Pathway (APP)
• MIPS Value Pathways (MVPs)

Traditional MIPS

It started in the same year as QPP and is the first reporting option for any MIPS eligible clinician. It is the preferred option unless they need to (or choose to) use the Alternative Payment Model (APM) Performance Pathway (APP) or the MIPS Value Pathway (MVP).

Generally, clinicians or MIPS Qualified Registries on their behalf can manage the whole reporting process.

How To Report MIPS 2021 Data to CMS?

Medical professionals need to report the measures and activities that they collect during the performance period.

Categories

It consists of four categories

• Quality
• Promoting Interoperability
• Improvement Activities
• Cost

Quality

It deals with the quality of care that the patients get from professionals, and it depends on measures put forth by the CMS.

The participants need to report at least six measures to qualify, and for MIPS 2021 reporting, it makes up 40% of the MIPS final score.

Promoting Interoperability

This category counts on

• Patient Engagement
• Patient-Clinician Interaction
• The health information exchange using Certified Electronic Health Record Technology (CEHRT)

There are a total of eleven measures in this category that come under four objectives. It makes up 25% of the total score.

Improvement Activities

It assesses clinicians by how much they improve their care processes and services, enhances patient engagement in healthcare, and provides increased access to healthcare.

Clinicians can choose the activities they require to qualify. It makes up 20% of the total score.

Cost

This category assesses the costs of the care that clinicians give to their patients. Moreover, it calculates the cost of the procedures based on the gathered Medicare claims data with a 15% weight of the final score.

Alternative Payment Model (APM) Performance Pathway (APP)

APP is the second reporting framework. Its job is to reduce the reporting burden on clinicians, offer new opportunities to participants, and encourage participation in MIPS APMs.

Categories

APP’s categories are as follows:

• Quality
• Promoting Interoperability
• Improvement Activities

All these categories get scored the same way as the traditional MIPS ones over the MIPS Qualified Measures. You can consult a MIPS Qualified Registry to take care of your administrative load.

MIPS Value Pathways

It refers to the list of measures and activities that were established and used to meet the requirements of MIPS 2021 reporting.

Their main reason for existence is to align all the different activities across different MIPS categories for multiple conditions. Basically, it wants to simplify the whole reporting system so that,

• People don’t hesitate while reporting, or
• Worry about not qualifying for it

Using this framework lets clinicians keep patients at the core of their job, which is the main requirement. Moreover, you can hire MIPS consultants for the reporting process to manage data as per the CMS guidelines.

Besides better health outcomes and lower treatment costs for patients, the performance data of MVPs will help patients make more informed healthcare decisions. But no matter how smooth the transition to MVPs is, it does not eliminate the traditional MIPS framework. At least not immediately.

MVP Guidelines

The MVP guidelines are as follows:

• Comprises a variety of MIPS quality measures that are useful for clinicians
• Has activities that can generate valuable data for clinician evaluations and decision-making. So that patients know about their care
• Incorporate the selected measures using the Meaningful Measure Approach, and include the patient’s voice wherever possible.
• Increase APM participation by including measures that come under APMs, and by linking cost and quality measures.
• Help and support the change to digital quality measures

Conclusion

All in all, the MIPS 2021 reporting is different than it seems for the upcoming years. For instance, MVPs were supposed to be active this year. However, with the Corona situation going on, slight changes have been made in the program.

It will be part of the MIPS 2022 reporting period.

A little description of this incentive payment program will take you ahead and score more for high incentives.