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    MIPS: How you will be measured going forward

    ‘Composite score’ incorporates quality performance, cost, EHR use, clinical practice improvement


    Cost. Clinicians will be measured on cost as they are today under the VBM program. Historical results are also available on the QRUR report. CMS will attribute the costs and calculate the score based on claims data and require no reporting by clinicians for the three measures: total per capita cost, Medicare spending per beneficiary, and episode measures if applicable. There are three episode measures that could be triggered by a urology care event: prostatectomy for prostate cancer, transurethral resection of the prostate for BPH, and kidney and urinary tract infection. Urologists should examine their QRUR reports and determine whether costs under the VBM have been attributed by one of these episodes to better understand their exposure under MIPS.

    Example of MIPS adjustment factors based on composite performance score

    Advancing Care Information. This replaces and simplifies the meaningful use program. There is a path defined with options for providers who were planning to attest for Stage 2 or 3 in 2017, and Stage 3 in 2018. The score in this category involves a qualitative score for participating in six activities, and a quantitative score for performance in three of those areas: patient electronic access, coordination of care through patient engagement, and health information exchange.

    Also see: What overpayments rule means for your practice

    All of the proposed objectives and measures map to the current Stage 3 requirements, and several Stage 3 requirements have been eliminated or made optional (for example, reporting to a specialized registry is now optional). As with the current meaningful use timeline, clinicians and their EHR vendors will need to upgrade to the 2015 certified EHR edition by Jan. 1, 2018 to report under MIPS.

    Next: Pay adjustments will be begin in 2016

    Robert A. Dowling, MD
    Dr. Dowling is president of Dowling Medical Director Services, a private health care consulting firm specializing in quality ...


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