MHA FPX 5068 Assessment 1 Merit-Based Incentives and Daily Operations

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Capella university

MHA-FPX 5068 Leadership, Management and Meaningful Use of Health Care Technology

Prof. Name

Date

Merit-Based Incentives and How they Affect Daily Operations

The Merit-Based Incentive Program System (MIPS) was established under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) to transition the healthcare industry from fee-for-service to value-based payment models. Effective since January 2017, MIPS determines Medicare payment adjustments based on a composite performance score. Eligible clinicians may receive payment bonuses, penalties, or no adjustments based on their final MIPS score (Centers for Medicare and Medicaid Services [CMS], 2021). The MIPS score comprises four performance categories: quality, improvement activities, promoting interoperability, and cost, which are calculated by CMS using measures and activities reported by organizations (Berdahl et al., 2019).

Consolidating previous quality reporting programs, MIPS aims to reduce financial penalties for physicians and increase potential bonus payments (Rathi, 2019). However, challenges such as the lack of incentives for providers in fee-for-service models and difficulties in aligning stakeholders persist. Simplification of quality measures across reimbursement programs could alleviate these challenges (Eggleton, Liaw, & Bazemore, 2017).

To benefit beneficiaries, quality data must be presented in a user-friendly format, yet challenges with documentation standards hinder alignment among payers and providers (Berdahl et al., 2019; Johnson et al., 2020). Collaboration between organizations, payers, providers, and quality measurement professionals is essential to mitigate these challenges (Berdahl et al., 2019).

Exclusions from MIPS eligibility include participation in Alternative Payment Models (APMs), low Medicare beneficiary volume, and providers new to Medicare. Meeting MIPS measures requires selecting appropriate measures aligned with organizational strengths, investing in MIPS technology, and educating clinicians (Eggleton et al., 2017; Rutherford, 2017).

Failing to meet MIPS measures incurs penalties and impacts reimbursement rates. Participating in MIPS offers incentives for performance improvement, whereas non-participation leads to lower reimbursement rates and missed bonus opportunities (Berdahl et al., 2019; Khullar et al., 2021).

Conclusion

Management strategies should focus on improving MIPS performance by educating clinicians, integrating MIPS requirements into workflows, ensuring accurate clinical documentation, and appointing MIPS champions. These efforts safeguard financial stability and enhance patient care quality.

References

Berdahl, C. T., Easterlin, M. C., Ryan, G., Needleman, J., & Nuckols, T. K. (2019). Prminay care physicians in the merit-based incentive payment system (MIPS): A qualitative investigation of participants’ experiences, self-reported practice changes, and suggestions for programm administrators. Journal of General Internal Medicine: JGIM, 34(10), 2275-2281. https://doi.org/10.1007/s11606-019-05207-z

Centers of Medicare and Medicaid Serivces (CMS) (2021). Physician Quality Reporting System (PQRS) overview- CMS.gov. https://www.cms.gov/medicare/quality-initiatives-patient-assessmentinstruments/PQRS/downloads/PQRS_overviewfactsheet

MHA FPX 5068 Assessment 1 Merit-Based Incentives and Daily Operations

Eggleton, K., Liaw, W., & Bazemore, A. (2017). Impact of gaps in merit-based incentive payment system measures on marginalized populations. Annals of Family Medicine, 15(3), 255-257. https://doi.org/10.1370/afm.2075

Horvitz-Lennon, M., Breslau, J., & McConnell, K. J. (2022). Association between the meritbased incentive payment system and access to specialized behavioral health care for Medicare beneficiaries. JAMA Health Forum, 3(3), e220219. https://doi.org/10.1001/jamahealthforum.2022.0219

Johnston, K. J., Wiemken, T. L., Hockenberry, J. M., Figueroa, J. F., & Joynt Maddox, K. E. (2020). Association of clinician health system affiliation with outpatient performance ratings in medicare merit-based incentive payment system, JAMA: The Journal of the American Medical Association, 324(10), 984-992. https://doi.org/10.1001/jama.2020.13136

Khullar, D., Bond, A. M., Qian, Y., O’Donnell, E., Gans, D. N., & Casalino, L. P. (2021). Physician practice leaders’ perception on Medicare’s merit-based incentive payment system (MIPS). Journal of General Internal Medicine: JGIM, 36(12), 3752-3758. https://doi.org/10.1007/s11606-021-06758-w

Manchikanti, L., Helm li S., Calodney, A K., & Hirsch, J. A. (2017). Merit-based incentive payment system: Meaningful changes in the final rule brings cautions optimism. Pain Physician, 20(1), E1-E2. https://doi.org/10.36076/ppj.2018.6.E1

Miller, L. E., Kondamuri, N. S., Xiao, R., & Rathi, V. K. (2022). Otolaryngologist performance in the merit-based incentive payment system in 2018. Otolaryngology-Head and Neck Surgery, 166(5), 858-861. https://doi.org/10.1177/01945998211032896