The Merit-based Incentive Payment System (MIPS)
MIPS combines performance across four categories to give a score on a 0-100 point scale. The score is then used to calculate a payment adjustment.
The weighting for each of the four MIPS categories – Quality, Cost, Promoting Interoperability, and Improvement Activities – in 2023 are below. Note that hospitalists’ weighting typically differs from the average MIPS clinician due to an exemption from Promoting Interoperability.
The Quality category replaces the PQRS and requires providers to report on quality measures. Scoring in this category will be based on performance on those measures providers choose to report.
In 2023, providers will be required to report on at least six quality measures, one of which is an outcome measure. For hospitalists, the quality category will be 55% of their MIPS score in 2021. Most hospitalists will not have enough quality measures to report and will be subject to a validation process to ensure there are no other measures available to them.
Promoting Interoperability is centered around the use of Certified Electronic Health Record Technology (CEHRT). Hospitalists are typically exempt from Promoting Interoperability if they meet the definition of “hospital-based,” which would shift the category weight to the Quality category. “Hospital-based” is defined as providers who bill 75% or more of Medicare Part B services in Place of Service 19 (off-campus outpatient hospital), 21 (inpatient), 22 (hospital outpatient) and 23 (ER).
Hospitalists who practice significantly (>25% of services) in settings such as skilled nursing facilities (SNFs) will still be subject to this category. SHM recommends these providers apply for hardship exceptions if they are unable to meet the category requirements.
The Improvement Activities category is based upon providers completing a range of activities designed to improve or expand provided care. CMS created an Improvement Activities inventory, with more than 100 activities assigned weights of high (20 points) or medium (10 points). Providers need to attest to 40 points worth of activities during the performance year.
The Cost category comprises cost and efficiency measures, such as the Total Per Capita Costs and Medicare Spending Per Beneficiary measures, and Episode-based Cost Measures. Scoring in this category is based on performance in CMS-calculated cost measures.