Originally posted by MEDScape.

The Centers for Medicare & Medicaid Services (CMS) has announced that by the end of May, it will notify all clinicians who are eligible for payment under the new Merit-Based Incentive Payment System (MIPS). One of two payment tracks in CMS’ Quality Payment Program, MIPS was launched January 1. Physicians who are subject to MIPS will have their performance on quality, electronic health record (EHR) use, and practice improvement measured this year to determine positive or negative payment adjustments in 2019.

Physicians and other clinicians are subject to MIPS if they bill more than $30,000 a year in Medicare Part B allowed charges a year and provide care for more than 100 Part B–enrolled Medicare beneficiaries annually. They are exempt from MIPS, however, if they receive a specified percentage of income from one of several care delivery models that are known as advanced alternative payment models.

CMS originally said it would notify clinicians who must participate in MIPS by last December, before the 2017 performance measurement period began. But CMS failed to do that, leaving many physicians and group practices in limbo. In March, the Medical Group Management Association (MGMA) sent a letter to CMS Administrator Seema Verma, protesting the delay in notification.

Anders Gilberg, senior vice president of MGMA, told Medscape Medical News the association was pleased that CMS was finally notifying physicians about their MIPS eligibility. “This information is critical to groups that want to succeed in the program in 2017,” he said.

Unresolved Issues

CMS has still not moved on a couple of important side issues, however, he noted. For one thing, it is still not clear which “non-patient-facing” physicians, who perform most of their services in the hospital, are subject to the Advancing Care Information category of MIPS. These physicians, including anesthesiologists and radiologists, do not have to meet Advancing Care Information requirements if they provide more than 75% of their services in a hospital. So eligibility could affect their need for an EHR, Gilberg pointed out.

CMS recently released a list of “qualified registries” clinicians can use to report their quality data, he said. But the agency has not issued a list of approved “qualified clinical data registries.” The qualified registries are mainly offered by EHR vendors, which can charge hefty fees for the service. In contrast, the more reasonably priced qualified clinical data registries are operated by specialty societies and quality improvement collaboratives.

Gilberg views this omission as a challenge for some practices that want to report more data to CMS this year to qualify for a bonus in 2019. (Physicians also have other options under CMS’ “pick your pace” reporting program, which allows them to do minimal reporting to avoid a penalty in 2 years.) These practices might be reluctant to use a qualified clinical data registry without knowing it is approved, he points out.

Overall, delayed notification of MIPS eligibility has caused problems for many practices, he said. He cited a large Michigan group that has been purchasing smaller practices, each of which has a different tax identification number. Because CMS determines eligibility on the basis of a tax identification number, some of those practices might have to report to MIPS, and others might not, creating problems for the parent group.

“Without having the baseline eligibility data, even a sophisticated practice doesn’t have the information they need to make the decisions for 2017,” he said.

Gilberg said he expects CMS to notify physicians of their MIPS eligibility for 2018 by December. “CMS’ own regulation says they’re going to do it, and we expect they’re going to follow their own regulation.”

Meanwhile, MGMA and other physician associations are advocating for a 90-day quality reporting period in 2018, rather than the currently mandated full-year period. “And if CMS can’t come up with a clear, transparent, cost measurement method, we’ll continue to advocate for zeroing out the cost component of MIPS in 2018,” Gilberg said. CMS is not measuring the costs of practices this year under MIPS, but it is supposed to start looking at that in 2018.

CMS’ requirement that all MIPS participants use 2015 Edition EHRs presents practices with another quandary. So far, only two major EHR vendors, Epic and Allscripts, have had their 2015 Edition EHRs certified by the government. There is serious concern in the industry that the bulk of eligible clinicians will not have 2015 EHRs by the start of the 2018 reporting period.

Partly for that reason, the Health Information and Management Systems Society recently asked CMS to delay the start date of the EHR mandate from January 1 to July 1, 2018. MGMA, the American Medical Association, and many specialty and state medical societies sent CMS a similar letter in February.

According to Gilberg, CMS is open to modifying this requirement as well as the implementation date. Under the leadership of Tom Price, MD, he says, the US Department of Health and Human Services, which includes CMS, is receptive to considering whether 2015 Edition EHRs are needed. Until that issue is resolved, he said, there is no reason for practices to upgrade their EHRs, because they have a 90-day reporting period for Advancing Care Information next year.