Arguably, one of the most confusing terms (and one of the most likely to make healthcare professionals squirm) is Medicare. Not for the care it brings individuals, but for the confusing rules and regulations put forth by CMS every year. Filled with acronyms (and acronyms within acronyms), it can be confusing and can often feel like your least favorite on-again, off-again relationship (of which I have a few, but that’s for a different blog post).

But, by understanding and “debuzzing” some of CMS’s common buzzwords, we can start to better understand how to succeed in the future of healthcare, make more money and, ultimately, provide better patient care.

See below ten Medicare buzzwords, debuzzed.

  1. Merit-based Incentive Payment System (MIPS): The Merit Based Incentive Payment System (MIPS) was established under Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. MIPS is an advanced payment model (APM) designed to provide incentives for providers for certain quality measures, improvement activities, and the use of EMRs that meet certain standards.
  2. Quality Payment Program (QPP): The QPP was created via MACRA and looks to reform Medicare Part B in all areas of health care that it applies. Its goals is to improve patient outcomes, reduce the burden on clinicians, increase the adoption of APMs (like MIPS) and much more.
  3. Medicare Access and CHIP Reauthorization Act (MACRA): The Medicare Access and CHIP Reauthorization Act of 2015 is a two-track QPP (and one of the few acronyms that houses another acronym that I know of). The two tracks included within MACRA are APMs and MIPS. Contrary to popular belief, MACRA likely isn’t going anywhere and actually has vast support throughout Congress for its ability to push clinicians from volume to value. Its pace at which it will be able to “make moves” though remains in question.
  4. Functional Limitation Reporting (FLR): You’re likely very familiar with this term, but do you know what the future holds for FLR? Announced in July 2018, CMS is proposing to retire this hotly debated requirement in 2019 – which is a largely celebrated move. It seems after a five-year experiment, complete with bureaucratic bungling they have finally concluded the obvious: this was a burdensome, ill-conceived exercise in garbage data collection. Stay tuned for the final rule to come out later this year though as this retirement is nothing more than a proposal at the time of this writing.
  5. Alternative Payment Models (APMs): The primary purpose of APMs is to move clinicians away from the previous fee-for-service model to value-based care. It’s an approach to payment that gives added incentives to providing high-quality, cost-efficient care. APMs have a variety of applications and can apply to a specific condition, care episode, or a population.
  6. Accountable Care Organization (ACO): Simply put, an ACO is a group of doctors, hospitals and other healthcare providers who have come together to pledge to give higher quality care to the Medicare patients they serve. Individuals participating in ACOs have laid much of the ground and prep work for changes like MACRA to take place and be successful.

The Four MIPS Performance Categories:

  1. Quality Measures: Partly developed from PQRS, this performance category is one of the two proposed components of a physical and occupational therapists MIPS score and could factor 85 percent of their score.
  2. Improvement Activities: A new category that rewards eligible clinicians focused on care coordination, beneficiary engagement, and patient safety. This is the other category that will make up a physical or occupational therapists MIPS score and would account for the remaining 15 percent.
  3. Promoting Interoperability: This aims to promote patient engagement and electronic exchange of information using certified electronic health record technology. Formerly called Advancing Care Information, and prior to that, Meaningful Use.
  4. Cost: The last of the four reporting categories under MIPS, cost measures aim to measure how a particular clinician or group impacts a patient’s cost, either directly or indirectly.

This information above is far from everything you need to know in order to participate in and be successful in MIPS. But, it is my hope that it provides some clarity in understanding the changes coming to healthcare, why it’s important to pay attention and how the changes can propel our profession forward to provide better care for our patients. Stay tuned as we bring you more updates.

Disclaimer: The information provided herein is intended to be general in nature. It is not offered as legal or insurance related advice, and is not a complete description, or meant, or intended, to replace or be interpreted as specific, of Medicare requirements. Although every effort has been made to ensure the content herein is correct, we assume no responsibility for its accuracy. Contact Department of Health & Human Services (DHHS) Centers for Medicare and Medicaid (CMS) Services for more information.


Leave a Reply

Your email address will not be published. Required fields are marked *