Assessment of Merit-based Incentive Payment System Improvement Activities

Pressure to improve quality of patient care and control costs is desired over the traditional volume driven fee-for-service reimbursement health care models (Squitieri, Bozic, & Pusic, 2017). Laws have been enacted to reward high performance Medicare clinicians and decrease payments to clinicians who fail to meet performance benchmarks (CMS, 2019 QPP).Merit-based Incentive Payment System (MIPS) is one of two ways providers receivereimbursement from the Medicare Quality Payment Program (QPP) intended to link payments to quality and cost-efficient care, improve processes and outcomes, increase use of healthcare information and reduce cost of care (CMS, 2019 MIPS). Physician reimbursement is determined by a score related to performance categories that include Quality, Promoting Interoperability (PI), Improvement Activities, and Cost (2019). Figure 1 provides an example of how provider groups would receive a Performance Category Score for their overall MIPS payment adjustment. This capstone will focus on the Improvement Activities category that includes use of Patient Reported Outcomes (PROs), Patient Portal, and Patient's Experience of Care Surveys. The Quality Department at the Healthcare System is responsible for tracking Improvement Activities within MIPS. They also serve as a reference for any department that has questions about MIPS and what they can do to improve their Improvement Activity score. Given the need to meet MIPS requirements, this project has the following objectives: a) to assess the usage of PROs, Patient Portal, and Patient's Experience of Care Surveys across multiple specialty groups to determine what performance activities need to be improved to meet goals for the Quality Payment Program, and b) recommend strategies to ensure specialty groups address their unique deficiencies regarding Improvement Activity scores and what they can do to meet their quality goals.