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MIPSHOW 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 LINEDr. Whitley will receive Medicare payment adjustments beginning in 2019 based

on how far o� she is from the performance benchmark (which CMS sets yearly).

STAY TUNED T0 ATHENAINSIGHT.COMTO FIND OUT HOW DR. BARBARA WHITLEY PERFORMS ON THE FOUR MIPS CATEGORIES

QUALIT Y COST

C ARE CO ORDINATION(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 �ctional,

average clinician navigates her �rst 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(DE ADLINE IS O CT. 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 �exibility 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 MIP S SCORE PAYMENT ADJUSTMENTS – TR ANSITION YE AR

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 POSIT IVE ADJUSTMENT

-4%

MAXIMUM POSIT IVE ADJUSTMENT

2 HER REPUTATION IS ON THE LINEFrom now on, Dr. Whitley’s performance data will be available to

the public through the Medicare.gov Physician Compare website.

3

OPTION4

OPTION2

OPTION1

PAYMENT

ADJUSTMENT

INFORMATION CURRENT A S OF THE O CTOBER 2016 RULING.

2017YE AR

2017

©2017athenahealth, Inc.

QUALIT Y COSTC ARE CO ORDINATION EHR USE

60

50

30

2017

2018

2019

CATEGORY WEIGHT CHANGES OVER TIME

30 15 25

10 15 25

15 25

©2017athenahealth, Inc. S O U R C E : Centers for Medicare & Medicaid Services

2017 MIPS SCORE PAYMENT ADJUSTMENTS – TRANSITION YEAR

0%

SCORE (POINTS)

FULL NEGATIVE ADJUSTMENT

NEUTRAL ADJUSTMENT

+4%

0 3 4–70 70–100

SOME POSIT IVE ADJUSTMENT

-4%

MAXIMUM POSIT IVE ADJUSTMENT

PAYMENT ADJUSTMENT

©2017athenahealth, Inc. S O U R C E : Centers for Medicare & Medicaid Services

90 consecutive days(DE ADLINE IS O CT. 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:

3 421

DURING 2017, THERE ARE FOUR OPTIONS FOR PARTICIPATING IN MIPS

©2017athenahealth, Inc. S O U R C E : Centers for Medicare & Medicaid Services