MIPS: Cost Category
December 29, 2016
Written by Sarah Leake
When CMS released the final ruling for the MIPS program last month, there was a slight sigh of relief as the cost category was assigned a 0% weight factor for the 2017 performance year. With the MIPS “pick your pace” concept, it will be extremely easy and very tempting for eligible clinicians and groups to overlook the cost category in 2017, since it will have no bearing on the composite score.
For those who were hoping that the “cost” factor would somehow disappear, fade away, or be eliminated due to changes in leadership, note that our country is facing a significant deficit in the health care fund that if left unattended could bankrupt our economy. In January 2015 and then again on March 3, 2016, CMS publicly announced its commitment to transition Medicare from fee-for-service (FFS) payments to value-based reimbursement to help drive healthcare reform. The two actions planned by CMS were –
• 30% of FFS payments will be tied to alternative payment ACO or bundled payment arrangements by the end of 2016, and 50% by the end of 2018
• 85% of all traditional Medicare payments will be tied to quality or value by 2016, and 90% by 2018 through programs like hospital value-based purchasing and hospital readmission reductions
CMS has been partnering with private, public, and non-profit organizations to help implement health care reform as the industry converts from volume to value. Patient care and payment models have been established with the goal to provide higher quality care while simultaneously reducing costs by increasing our focus towards personalized and preventative care.
Recognizing that cost reduction efforts require significant investments in time and money, CMS deferred the cost evaluation category in 2017 to give eligible clinicians more time to develop payment models that focus on improving quality and care delivery through the use of technology to reduce per capita and per beneficiary costs without sacrificing quality. Over the next three years, cost control will become one of the key factors in evaluating overall performance as evidenced by the increase in weight factor percentages.
Summary of the MIPS Weight Factor by Category by Year
Developing a plan and setting reasonable goals now will help eligible clinicians take back control and keep focus on what’s really important – improving the care and well-being of the patient.
Here are some simple steps to help take back control and navigate the journey through MIPS –
• Use data (i.e. QRUR or PQRS reports) to help assess your current performance and identify programs and measures that will be most beneficial.
• Leverage on existing success stories to identify areas for improvement. Focus on reducing cost rather than increasing revenue, since value-based payment programs focus on decreasing the overall cost to deliver care without sacrificing quality.
• Develop partnerships with key stakeholders and support teams to assist with sharing knowledge and closing gaps that are critical to your success. Data analytics have proven to be extremely valuable because it links clinical with financial data optimizing opportunities for cost reduction through standardization and evidence-based protocols.
As 2016 comes to a close, it seems appropriate to say “time flies” and before we know, the 10% weighted cost factor will be here. Start reviewing your cost metrics today, while time is still on your side.
Post contributed by Christine Asato, QIO, Mountain-Pacific in Hawaii.
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