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Learn About MACRA

The Merit-Based Incentive Payment System



One half of the new Medicare Quality Payment Program (QPP) created by MACRA, participants in the Merit-Based Incentive Payment System will receive a MIPS final performance score based on their participation in four individual performance categories.

If you see less than 200 Medicare Part B patients during a MIPS reporting year OR have Medicare Part B billing charges less than or equal to $90,000, you are excluded from participation in the Quality Payment Program. CMS will review your previous Medicare Part B patient and billing volume to determine if you are excluded. CMS has created a lookup tool where physicians can verify their MIPS eligibility status. Visit www.qpp.cms.gov.

Eligible clinicians must submit data on:

  1. Six quality measures, including one outcome or high priority measure
  2. Minimum 2 IAs, depending on practice size
  3. Base measures plus at least one performance measure in the ACI category
Performance ComponentMinimum Reporting Period For 2018
Quality12-months
Cost12-months
Improvement Activities90-days
Advancing Care Information90-days
Replaces the Physician Quality Reporting System (PQRS)
Percentage of 2017 MIPS Final Score: 60%
How this Performance Category applies to you, by Practice Type/SettingTo Avoid a PenaltyTo Receive a Payment BonusMIPS Performance Category Score Bonus OpportunitiesASPS Developed Support
  • Solo
  • Small Group (≤15 MIPS-eligible clinicians)
  • Other Group (≥16 MIPS-eligible clinicians)

Submit 1 quality measure, 1 Clinical Practice Improvement Activity, or the core ACI measures by CMS Claims (deadline: Dec 31, 2017), Qualified Registry or Qualified Clinical Data Registry (deadline: March 31, 2018 - please note, submission deadlines may vary by the mechanism you choose)

NOTE: For 2017, each MIPS performance category has one minimum threshold activity. Completing one of these will allow you to avoid a penalty program-wide

Eligibility for Small Bonus: Submit at least 6 quality measures on 90 consecutive days of data (You must begin collecting data by October 2, 2017)

Eligibility for Larger Bonus: Submit a full year of data

Submit 6 quality measures, including at least one outcome measure; or

Submit 6 quality measures within the Plastic Surgery Measure Set, including 1 outcome measure

2 bonus points for each outcome and patient experience measure reported

Bonus points are available for measures that are not scored* as long as the measure has the required case minimum and data completeness

1 bonus point for each measure submitted with end-to-end electronic reporting for a quality measure under certain criteria

* Those not included in the top 6 measures for the quality performance category score

ASPS has tools to help you track, measure, and report on those measures, as well as additional relevant measures

Learn more about the ASPS QCDR at plasticsurgery.org/QCDR.

Access Quality Reporting Tools

  • CMS Web Interface (≥25 MIPS-eligible clinicians)

Submit 15 quality measures for 1 full year

Eligibility for Small Bonus: Submit at least 6 quality measures on 90 consecutive days of data. (You must begin collecting data by October 2, 2017)

Eligibility for Up to 4% Bonus: On 90 consecutive days of data (you must begin collecting data by October 2, 2017):

  • Submit 6 quality measures, including at least 1 outcome measure; or
  • Submit 6 quality measures within the Plastic Surgery Measure Set, including 1 outcome measure

2 bonus points for each outcome and patient experience measure reported

Bonus points are available for measures that are not scored* as long as the measure has the required case minimum and data completeness

1 bonus point for each measure submitted with end-to-end electronic reporting for a quality measure under certain criteria

* Those not included in the top 6 measures for the quality performance category score

The Plastic Surgery Measure set includes 11 measures that are recommended for the specialty

ASPS has tools to help you track, measure, and report on those measures, as well as additional relevant measures

Access Quality Reporting Tools

  • Advanced Alternative Payment Model

Report quality measures through your APM. No additional activity is required for this performance category

Replaces the Physician Quality Reporting System (PQRS)
Percentage of 2017 MIPS Final Score: 60%
Solo, Small Group (≤15 MIPS-eligible clinicians), Other Group (≥16 MIPS-eligible clinicians)
To Avoid a Penalty

Submit 1 quality measure, 1 Clinical Practice Improvement Activity, or the core ACI measures by CMS Claims (deadline: Dec 31, 2017), Qualified Registry or Qualified Clinical Data Registry (deadline: March 31, 2018 - please note, submission deadlines may vary by the mechanism you choose)

NOTE: For 2017, each MIPS performance category has one minimum threshold activity. Completing one of these will allow you to avoid a penalty program-wide

To Receive a Payment Bonus

Eligibility for Small Bonus: Submit 2 or more quality measures on 90 consecutive days of data (You must begin collecting data by October 2, 2017)

Eligibility for Larger Bonus: Submit a full year of data

Submit 6 quality measures, including at least 1 outcome measure; or

Submit 6 quality measures within the Plastic Surgery Measure Set, including 1 outcome measure

MIPS Performance Category Score Bonus Opportunities

2 bonus points for each outcome and patient experience measure reported

Bonus points are available for measures that are not scored* as long as the measure has the required case minimum and data completeness

1 bonus point for each measure submitted with end-to-end electronic reporting for a quality measure under certain criteria

* Those not included in the top 6 measures for the quality performance category score

ASPS Developed Support

ASPS has tools to help you track, measure, and report on those measures, as well as additional relevant measures

Learn more about the ASPS QCDR at plasticsurgery.org/QCDR.

Access Quality Reporting Tools

CMS Web Interface (≥25 MIPS-eligible clinicians)
To Avoid a Penalty

Submit 15 quality measures for 1 full year

To Receive a Payment Bonus

Eligibility for Small Bonus: Submit 2 or more quality measures on 90 consecutive days of data. (You must begin collecting data by October 2, 2017)

Eligibility for Up to 4% Bonus: On 90 consecutive days of data (you must begin collecting data by October 2, 2017):

  • Submit 6 quality measures, including at least one outcome measure; or
  • Submit 6 quality measures within the Plastic Surgery Measure Set, including 1 outcome measure
MIPS Performance Category Score Bonus Opportunities

2 bonus points for each outcome and patient experience measure reported

Bonus points are available for measures that are not scored* as long as the measure has the required case minimum and data completeness

1 bonus point for each measure submitted with end-to-end electronic reporting for a quality measure under certain criteria

* Those not included in the top 6 measures for the quality performance category score

ASPS Developed Support

The Plastic Surgery Measure set includes 11 measures that are recommended for the specialty

ASPS has tools to help you track, measure, and report on those measures, as well as additional relevant measures

Access Quality Reporting Tools

Advanced Alternative Payment Model

Report quality measures through your APM. No additional activity is required for this performance category

This is a new reporting category, with no predecessor among federal pay-for-performance programs
Percentage of 2017 MIPS Final Score: 15%
How this Performance Category applies to you, by Practice Type/SettingTo Avoid a PenaltyTo Receive a Payment BonusMIPS Performance Category Score Bonus OpportunitiesASPS Developed Support
  • Solo
  • Small Group (≤15 MIPS-eligible clinicians)
  • Practitioners in a rural or health professional shortage area

If opting to report the IA category instead of quality or ACI, attest to at least 1 medium-weighted improvement activity for 90 days.

The activities must begin no later than the 90-day period beginning October 2, 2017

Eligibility for Small Incentive: Earn a minimum of 20 points

Eligibility for Larger Incentive: Earn 40 points

Medium-weighted activities are 20 points each; High-weighted activities are 40 points each

The activities must begin no later than the 90-day period beginning October 2, 2017

Awarded to clinicians who can attest to using CEHRT functions when they carry out the activity

ASPS has identified the IAs most relevant to plastic surgery and other IAs that may be useful – or already in place – at some practices

Access IA Support

  • Other Group (≥16 MIPS-eligible clinicians)

Attest to at least 1 medium-weighted improvement activity for 90 days.

The activities must begin no later than the 90-day period beginning October 2, 2017

Eligibility for Small Incentive: Earn a minimum of 10 points, maximum 30 points

Eligibility for Larger Incentive: Earn 40 points, in any combination of high and medium weighted activities

Medium-weighted activities are 10 points each; High-weighted activities are 20 points each

Activities must begin no later than the 90-day period beginning October 2, 2017

Awarded to clinicians who can attest to using CEHRT functions when they carry out the activity

ASPS has identified the IAs most relevant to plastic surgery and other CPIAs that may be useful – or already in place – at some practices

Access IA Support

  • Advanced Alternative Payment Model
    Participants in:
    • certified patient-centered medical homes
    • comparable specialty practices
    • an APM designated as a Medical Home Model

Automatically receive points based on the requirements of the program

This is a new reporting category, with no predecessor among federal pay-for-performance programs
Percentage of 2017 MIPS Final Score: 15%
Solo, Small Group (≤15 MIPS-eligible clinicians), Practitioners in a rural or health professional shortage area
To Avoid a Penalty

If opting to report the IA category instead of quality or ACI, attest to at least 1 medium-weighted improvement activity for 90 days.The activities must begin no later than the 90-day period beginning October 2, 2017

To Receive a Payment Bonus

Eligibility for Small Incentive: Earn a minimum of 20 points

Eligibility for Larger Incentive: Earn 40 points

Medium-weighted activities are 20 points each; High-weighted activities are 40 points each

The activities must begin no later than the 90-day period beginning October 2, 2017

MIPS Performance Category Score Bonus Opportunities

Awarded to clinicians who can attest to using CEHRT functions when they carry out the activity

ASPS Developed Support

ASPS has identified the IAs most relevant to plastic surgery and other IAs that may be useful – or already in place – at some practices

Access IA Support

Other Group (≥16 MIPS-eligible clinicians)
To Avoid a Penalty

Attest to at least 1 medium-weighted improvement activity for 90 days.

The activities must begin no later than the 90-day period beginning October 2, 2017

To Receive a Payment Bonus

Eligibility for Small Incentive:  Earn a minimum of 10 points, maximum 30 points

Eligibility for Larger Incentive: Earn 40 points, in any combination of high and medium weighted activities

Medium-weighted activities are 10 points each; High-weighted activities are 20 points each

Activities must begin no later than the 90-day period beginning October 2, 2017

MIPS Performance Category Score Bonus Opportunities

Awarded to clinicians who can attest to using CEHRT functions when they carry out the activity

ASPS Developed Support

ASPS has identified the IAs most relevant to plastic surgery and other CPIAs that may be useful – or already in place – at some practices

Access IA Support

Advanced Alternative Payment Model Participants in: certified patient-centered medical homes, comparable specialty practices, an APM designated as a Medical Home Model

Automatically receive points based on the requirements of the program

Replaces the federal Electronic Health Records Incentive Program, also known as Meaningful Use
Percentage of 2017 MIPS Final Score: 25%
How this Performance Category applies to you, by Practice Type/SettingTo Avoid a PenaltyTo Receive a Payment BonusMIPS Performance Category Score Bonus OpportunitiesASPS Developed Support
  • Solo
  • Small Group (≤15 MIPS-eligible clinicians)
  • Other Group (≥16 MIPS-eligible clinicans)

Begin reporting on all of the required (base) measures for a minimum of 1 patient for 90 days by October 2, 2017:

  • 2014 CEHRT: 4 required (base) measures:
    • Security Risk Analysis
    • e-Prescribing
    • Provide Patient Access
    • Health Information Exchange
  • 2015 CEHRT: 5 required (base) measures:
    • Security Risk Analysis
    • e-Prescribing
    • Provide Patient Access
    • Send Summary of Care
    • Request/Accept Summary of Care

Eligibility for Small Incentive: Report on the base measures plus at least 1 ACI performance score measure for 90 days

Eligibility for Larger Incentive: To earn a higher score, you can report additional performance measures in an attempt to receive 100%

You must report on data covering at least 90 days, beginning no later than October 2, 2017

Report Public Health and Clinical Data Registry Reporting measures*

Use certified EHR technology to complete certain improvement activities in the improvement activities performance category

* these are generally not accessible to plastic surgeons; however, those in a multi-specialty group practice may be able to report these based on another provider's access

ACI can be reported via the ASPS QCDR. (Coming Soon)

Replaces the federal Electronic Health Records Incentive Program, also known as Meaningful Use
Percentage of 2017 MIPS Final Score: 25%
Solo, Small Group (≤15 MIPS-eligible clinicians), Other Group (≥16 MIPS-eligible clinicians), Advanced Alternative Payment Model
To Avoid a Penalty

Begin reporting on all of the required (base) measures for a minimum of 1 patient for 90 days by October 2, 2017:

  • 2014 CEHRT: 4 required (base) measures:
    • Security Risk Analysis
    • e-Prescribing
    • Provide Patient Access
    • Health Information Exchange
  • 2015 CEHRT: 5 required (base) measures:
    • Security Risk Analysis
    • e-Prescribing
    • Provide Patient Access
    • Send Summary of Care
    • Request/Accept Summary of Care
To Receive a Payment Bonus

Eligibility for Small Incentive: Report on the base measures plus at least 1 ACI performance score measure for 90 days

Eligibility for Larger Incentive: To earn a higher score, you can report additional performance measures in an attempt to receive 100%

You must report on data covering at least 90 days, beginning no later than October 2, 2017

MIPS Performance Category Score Bonus Opportunities

Report Public Health and Clinical Data Registry Reporting measures*

Use certified EHR technology to complete certain improvement activities in the improvement activities performance category

* These are generally not accessible to plastic surgeons; however, those in a multi-specialty group practice may be able to report these based on another provider's access

ASPS Developed Support

ACI can be reported via the ASPS QCDR. (Coming Soon)

Replaces the Value-Based Modifier
Percentage of 2017 MIPS Final Score: 0%
How this Performance Category applies to you, by Practice Type/SettingTo Avoid a PenaltyTo Receive a Payment BonusMIPS Performance Category Score Bonus OpportunitiesASPS Developed Support
In 2017, this will be calculated based on adjudicated claims. No submission required

You will be scored on your resource use in the future, most likely beginning in 2018. ASPS has tools to help you identify opportunities to make your resource use more efficient

Access Resource Use Analysis Tools

Replaces the Value-Based Modifier
Percentage of 2017 MIPS Final Score: 0%

In 2017, this will be calculated based on adjudicated claims. No submission required

ASPS Developed Support

You will be scored on your resource use in the future, most likely beginning in 2018. ASPS has tools to help you identify opportunities to make your resource use more efficient

Access Resource Use Analysis Tools

You can obtain a Merit-based Incentive Payment System (MIPS) final performance score by participating in some or all of the four MIPS performance categories: (1) the Advancing Care Information (ACI) Performance Category; (2) the Improvement Activities (IA) Performance Category; (3) the Quality Performance Category; and (4) the COST Performance Category. The more you participate, the higher your score.

Your performance in each category is scored individually based on whether and how well you conduct activities specified within it. The individual MIPS performance category scores are weighted differently (for 2018, the weights are: ACI - 25%; CPIAs - 15%; Quality - 50%; COST - 10%), and are aggregated to produce a MIPS final performance score.

Your MIPS final performance score is used to benchmark your performance relative to all other MIPS physicians. Your Part B payments will be increased, decreased or remain neutral based on how your score ranks relative to the full field of final scores.

Additional Help Understanding Scoring

CMS has announced the inclusion of Virtual Groups with year 2 of the QPP as an additional participation option. A Virtual Group is a combination of 2 or more Taxpayer Identification Numbers (TINs) made up of solo practitioners and/or groups of 10 or fewer eligible clinicians who come together "virtually" (no matter specialty or location) with others to participate in MIPS for a yearly performance period. To be eligible to join or form a virtual group you would need to be a solo practitioner who exceeds the low volume threshold individually and are not a newly Medicare enrolled eligible clinician, a Qualifying APM Participant (QP) or a Partial QP choosing not to participate in MIPS. If you are a group of 10 or fewer eligible clinicians and exceed the low volume threshold at the group level, you are eligible to participate.