MACRA MIPS, Promoting Interoperability (PI) Guide!

Welcome to our guide on MACRA MIPS and the Promoting Interoperability (PI) category! As healthcare providers navigate the ever-changing landscape of Medicare reimbursement, understanding the intricacies of MIPS is essential for optimizing performance and maximizing incentives. In this blog, we will focus primarily on the Performance Improvement category, which is pivotal for providers looking to enhance their quality of care, patient outcomes, and overall practice efficiency within the MIPS framework. Let’s dive into the details and explore how providers can excel in the Performance Improvement category to thrive in value-based care.

 What is MACRA MIPS?

MACRA stands for the Medicare Access and CHIP Reauthorization Act, which was enacted in 2015 to reform Medicare payments and move towards a value-based care model. MIPS, on the other hand, is the Merit-based Incentive Payment System, one of two tracks under MACRA, the other being Advanced Alternative Payment Models.

 Basic Categories of MIPS

MIPS consolidates three existing programs into one performance-based payment system and evaluates providers based on four performance categories:

  1. Quality: This category focuses on the quality of care provided to patients. Providers report on various quality measures, such as preventive care, chronic disease management, and patient safety.
  2. Promoting Interoperability (PI): Formerly known as Advancing Care Information (ACI), this category assesses how well providers use certified EHR technology to engage patients and share health information securely.
  3. Improvement Activities (IA): This category measures participation in activities that improve clinical practice. Activities can include care coordination, patient engagement, and population health management.
  4. Cost: This category evaluates the total cost of care attributed to a provider and considers Medicare claims data to assess resource use and costs relative to quality outcomes.

 The Promoting Interoperability (PI) Category

The PI category of MIPS incentivizes healthcare providers to embrace and enhance interoperability through the meaningful use of certified electronic health record (EHR) technology. To meet the requirements of the PI category, providers must:

  1. Use an electronic health record (EHR) that meets the certification criteria at 45 CFR 170.315 and submit its CMS identification Code: Providers must utilize EHR technology that complies with specific certification criteria outlined in the Code of Federal Regulations (CFR). Providers must also submit their EHR’s CMS identification code to demonstrate compliance.
  2. Submit data for required measures for 180 consecutive days or more: Consistent submission of data for specified measures related to interoperability for a minimum of 180 consecutive days within the performance year is required. Measures may include electronic exchange of patient health information, patient access to health information, and health information exchange with other providers.
  3. Attest “yes” to the Actions to Limit or restrict Compatibility or Interoperability of CEHRT Attestation: This attestation confirms that providers have not knowingly limited or restricted the compatibility or interoperability of their certified EHR technology (CEHRT) with other systems or technologies.
  4. Attest “yes” to the ONC Direct Review Attestation: Providers acknowledge compliance with additional standards and requirements established by the Office of the National Coordinator for Health Information Technology (ONC) by attesting “yes” to this requirement. Compliance includes adherence to guidelines for data exchange protocols, privacy, and security standards.
  5. Attest “yes” to the Security Risk Analysis Measure: Providers must conduct a comprehensive security risk analysis of their CEHRT to identify and mitigate potential risks to the confidentiality, integrity, and availability of electronic protected health information (ePHI).
  6. Attest “yes” to the Safety Assurance Factors for EHR Resilience (SAFER) Guides Measure: The SAFER Guides measure assesses providers’ adherence to best practices for ensuring the resilience and reliability of their EHR systems.

 Providers Affected by MIPS

According to the Quality Payment Program (QPP), the following clinician types are MIPS eligible for 2024:

  • Physicians
  • Osteopathic practitioners
  • Chiropractors
  • Physician assistants
  • Nurse practitioners
  • Clinical nurse specialists
  • Certified registered nurse anesthetists
  • Physical therapists
  • Occupational therapists
  • Clinical psychologists
  • Qualified speech-language pathologists
  • Qualified audiologists

Certain providers are exempt from MIPS, such as those who are new to Medicare, participate in Advanced APMs, or have low Medicare patient volumes.

 Why MIPS Matters

Participation in MIPS is essential for providers because it directly impacts their Medicare reimbursement. Based on their MIPS final score, providers receive positive, neutral, or negative payment adjustments to their Medicare Part B payments. High performers may earn bonuses, while low performers may face penalties. Moreover, MIPS reporting can enhance patient care, drive practice improvements, and position providers for success in value-based care models. In conclusion, MACRA MIPS represents a significant shift in how Medicare reimburses providers, emphasizing quality, interoperability, and cost-effective care. Understanding its categories and implications is crucial for eligible clinicians to navigate the changing healthcare landscape successfully. By embracing MIPS, providers can not only thrive financially but also deliver better outcomes for their patients.

Remember, each category contributes to the MIPS final score, with Quality at 40%, PI at 25%, Improvement Activities at 15%, and Cost at 20%. As the program evolves, these weights may change. Stay informed, embrace interoperability, and continue providing excellent care!