What you need to know about the Merit-based Incentive Payment System (MIPS)

Many health care administrators are familiar with the Centers for Medicare & Medicaid Services’ Meaningful Use guidelines.

Those guidelines define the minimum U.S. government standards for using electronic health records (EHR) and for exchanging patient data between health care providers, insurers, and between health care providers and patients.

What many health care professionals may not be aware of is that the government has recently shifted to a new framework called the Merit-Based Incentive Payment System (MIPS), which builds upon the Meaningful Use guidelines.

According to Christopher Miller, DHSc, MHM, health IT lead for Capella University, the adoption of the Meaningful Use guidelines and the incentives for health care providers to switch to EHRs have been extremely beneficial developments for both health care organizations and the patients they serve.

“Prior to the implementation of the Meaningful Use guidelines, it was often cumbersome for physicians to share patient records with each other efficiently and securely,” Miller explains. “In addition, it was difficult for the government to access the data it needs to track public health trends, such as disease rates by region. With the adoption of the Meaningful Use guidelines, we took a big step toward modernizing our health care data systems to help ensure health care professionals and the government have the information they need to serve individual patients and the broader public.”

MIPS aims to achieve the following:

• Improve health care quality, safety, efficiency, and reduce health disparities
• Engage patients and their families
• Improve care coordination and public health
• Maintain privacy and security of patient health information

The following are three key aspects of the MIPS framework that Miller encourages every health care administrator to know:

1. Meaningful use guidelines – It is critical to understand that the MIPS framework builds upon the Meaningful Use standards, Miller says. Those standards still have to be met and serve as the foundation for the MIPS framework.
   
2. Payments and incentives – The MIPS framework incorporates payment systems and quality control programs such as the Value Based Payment Modifier (VBN) and the Physician Quality Reporting System (PQRS). Miller says that while the ultimate goal of MIPS is increased quality of care and access to critical health data, it also results in a more complex payment infrastructure that health care administrators need to be equipped to navigate. “One of the main goals for Medicare and the MIPS framework is to keep health care costs under control,” Miller explains. “Health care organizations are financially incentivized by Medicare for careful implementation of the MIPS framework. Therefore, it’s important that health care leaders understand and properly utilize these payment systems to ensure they are maximizing their incentives.”
3. Interoperability– The ability for technology systems to communicate, exchange data, and use that information is one of the key objectives of the MIPS program, Miller says. He adds that health care administrators must have a clear understanding of how that interoperability works (or doesn’t) within their own EHR and health IT systems if they are to maximize their incentives offered through MIPS.

“The MIPS framework makes it all the more important for health administrators and leaders to be intimately involved and familiar with the health IT aspect of their organizations,” Miller concludes. “It is no longer a situation where they can just let IT handle it. The MIPS framework is tied to payments, productivity, and overall quality of health care. It’s core to everything health administrators are responsible for.”

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