This article was published in the September 2017 addition of the Journal of AHIMA and became available online in August 2017.
A large number of MACRA professionals have reported that many providers are enrolled in an aspect of the MACRA Quality Payment Program called MIPS APMs without their awareness. Providers who agreed to participate in Track 1 Accountable Care Organizations 2017, for example, and to otherwise meet the MIPS eligibility criteria are in MIPS APMs. Via a direct communication with CMS clinicians cannot elect out of the MIPS APM.
MIPS APMs have advantages but also potential disadvantages. All participants will receive the same MIPS score. The most common example would be a Track 1 ACO. In this model all providers will have their MIPS score determined based on the ACO’s performance on the ACO quality performance measures and each individual practice’s Advancing Care Information performance. One of the benefits of participating in a MIPS APM is that in most instances Medicare will automatically credit all participants with the maximum 15 points in the Improvement Activity performance category.
However, specialists who may be participating in ACO will not have much influence over the majority of the quality measures used to determine performance. If the ACO is performing well on the quality measures the practice may be eligible for a relatively high MIPS score. This will depend in part on how well they perform in the Advancing Care Information category. CMS will use a weighted average of ACI scores across the entire eligible ACO membership population of clinicians to determine a composite ACI score for the MIPS APM entity, i.e. the ACO.
This article discusses a number of considerations related to MIPS APMs that are not widely known in healthcare community.
The article was co-authored by Susan R. Bradshaw, MS, MBA, RHIA; Donald G. Krause, MBA, CPA; and Michael Marron-Stearns, MD, CPC, CFPC. Dr. Marron-Stearns is the CEO and founder of Apollo HIT, LLC.
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Bradshaw, Susan R; Krause, Donald G; Marron-Stearns, Michael. “MIPS APMs and How They May Impact Your MACRA Strategy” Journal of AHIMA 88, no.9 (September 2017): 22-25.