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Cost and Clinical Practice Improvement Activities (CPIA) Categories – MACRA Monday

Posted on January 30, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program.

We’re continuing to move through the various MIPS performance categories as we cover the details of MACRA. Today we’re going to cover the Cost and Clinical Practice Improvement Activities (CPIA) Categories.

MIPS Cost Category
We won’t cover much of the Cost (Formerly known as Resource Use) category since it has basically been relegated to future MACRA requirements. For those that missed it, the cost category has a weighting of 0% in 2017, so it basically won’t impact your MACRA payment adjustment at all. In 2017, they’re looking at feedback for this category, but it won’t affect your 2019 payments.

You’ll probably remember that the Cost category was the replacement to the value-based modifier and didn’t require any reporting on the part of the provider. Instead, the cost category is tracked using the Medicare claims data. This means that CMS will still have the data they need to evaluate this category without any additional work from providers.

MIPS Clinical Practice Improvement Activities (CPIA) Category
You’ll remember that the Clinical Practice Improvement Activities (CPIA) category is a new category that was added as part of MACRA. This category will account for 15% of your MIPS score. This category has some small practice exceptions and also special credit for those participating in a patient-centered medical home or other similar medical home model.

Under CPIA providers must choose from 90+ activities in the following 9 subcategories:

CPIA will be scored on a total of 40 points with “Medium” activities scoring 10 points and “High” activities scoring 20 points. These point totals are doubled for small, rural, and underserved practices. That means that small practices only need to do 1-2 activities to get full credit for this category. Larger practices only need to do 2-4.

The Cost and CPIA MIPS categories only make up 15% of your total MIPS score. So, they’re not going to be a significant impact on your MACRA score either way. However, if you do even just 1 improvement activity (CPIA), then you’ll avoid any negative payment adjustment thanks to MIPS pick your pace.

That’s all for this week’s MACRA Monday. Next week we’ll talk Advancing Care Information (ACI) or what most of you call meaningful use.

Be sure to check out all of our MACRA Monday blog posts where we dive into the details of the MACRA Quality Payment Program.

MIPS Overview – MACRA Monday

Posted on August 15, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This post is part of the MACRA Monday series of blog posts where we dive into the details of MACRA.

The Merit-based Incentive Payment System or MIPS as we now know it is going to be a big part of most practices future. As we mentioned previously, most practices will be participating in the MIPS program as opposed to the APM program under MACRA. Here’s a quick overview of the MIPS program. Over the next months, we’ll be diving deeper and deeper into the details of MIPS.

MIPS replaces 3 programs that will likely be familiar to most readers: PQRS, the Medicare EHR Incentive Program (Better known as meaningful use), and the Value-Based Payment Modifier (VBM). The last one might not be as familiar to people, but PQRS and Meaningful Use are likely very familiar. In future posts, we’ll dive into the changes to these programs that come as they’re rolled into MIPS.

It’s worth noting that these programs will continue to run in their current from through 2018. Plus, the Medicaid EHR Incentive Program and the Medicare EHR Incentive Program for Hospitals will continue. Along with rolling the 3 current programs into MIPS, MACRA also adds a new program to MIPS called the Clinical Practice Improvement Activities (CPIA).

The first performance period for MIPS is 2017 with MIPS adjustments happening in 2019. At least that’s the way it’s listed in the proposed rule. Many are suggesting that there’s no way that MIPS will be for all of 2017. They argue that it has to be either delayed or moved to a 90 day reporting period (which is basically a 9 month delay). We’ll see what they finally decide when the MACRA final rule finally comes out.

The potential MIPS adjustments to your Medicare Part B payment are 4% in 2019 and grow to 9% in 2022. Remember that these adjustments can be both positive and negative based on how well you participate in the MIPS program. We’ll dive into the MIPS Composite Score that determines your MIPS payment adjustment in a future post. Here’s a charge which illustrates the MIPS timeline and incentives:
MIPS Incentives and Penalties
That’s all for our MIPS overview. Next up we’ll dive into who is eligible for MIPS and who is not eligible for MIPS.

You can see how if you’re already participating in PQRS, Meaningful Use, and the Value-Based Modifier, then you are well positioned to do well in MIPS. This will become even more clear when we discuss the weighted scoring that each of these pieces of MIPS receives. Of course, if you haven’t been participating in these programs, then MIPS will definitely be a pretty big hill to climb.

Be sure to check out all of our MACRA Monday blog posts where we dive into the details of the MACRA program.