The Merit-Based Incentive Payment System (MIPS) was implemented with the intention of improving healthcare quality and value under Medicare. The idea originated under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which established a new performance-based framework for clinicians to be reimbursed by Medicare. This led to the Quality Payment Program (QPP) in 2017, and MIPS is one way to claim – it rewards clinicians for improving the quality of patient care and outcomes. Originally, it was offered to medical and osteopathic doctors, but in 2019, it expanded to include other health professionals, such as physical and occupational therapists (PTs and OTs).

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The MIPS performance year runs from January 1 to December 31 each year, and those eligible should report data by March 31 the following calendar year. Any payment adjustments will then be applied for the year following data submission (for example, if you record data for 2024, you will report it by March 2025 and receive payment adjustments in 2026).

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This blog will explore the MIPS performance categories (Quality, Improvement Activities, Promoting Interoperability, and Cost) to help you apply them to achieve the greatest success and outcomes.

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Categories

You will be evaluated on four performance categories over the course of the calendar year. You will need to collect and share data for each category. You will then receive your MIPS score, which ranges from 0 to 100. The score directly impacts Medicare reimbursements, so a higher score will result in incentives like increased payments, for example.

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You can participate as a group, individual, virtual group, or APM Entity.

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Quality

This assesses the quality of care you deliver based on various requirements and serves as 30% of your overall score.

• Report on measures related to patient-reported outcomes or process measures, such as the patient-reported outcomes measurement information system (PROMIS) pain interference/physical function, lower extremity functional scale, and modified low back pain disability questionnaire.
• Other process measures include BMI and medication lists.
• You will need to submit data for at least six quality measures or a complete specialty measure set.
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Improvement Activities

This evaluates how you are improving your care processes, enhancing patient engagement in care, and increasing access to care. It counts as 15% of the final score. Depending on your reporting requirements, you should perform between one and four improvement activities, including using digital engagement tools (like moveUP).

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Promoting Interoperability

This evaluates the use of certified electronic health record technology (CEHRT) and the exchange of health information to promote care coordination and patient engagement, which contributes to 25% of your final score. You will report a defined set of Promoting Interoperability objectives and measures.

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Previously, only certain clinicians had to report Promoting Interoperability data, but as of 2024, others, including PTs and OTs, are now required to submit data (the full list can be found on the QPP website).

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Cost

This evaluates the total cost of care provided using the Medicare claims data and counts as 30% of the final score.

For this category, you will not need to submit data yourself as it comes directly from Medicare. You will be evaluated on each cost measure for which you meet or exceed the established case minimum – you must meet this for at least one measure.  

By understanding these categories and choosing the appropriate measures/activities, you can get the best MIPS score possible and positively impact patient care. Once you submit all your activities, the QPP will calculate the cost measures applicable to you.

For a more detailed breakdown and to stay on top of the latest updates, head to the Quality Payment Program website or download the 2024 MIPS quick start guide.