MIPS: Streamlining Medicare Payment Adjustments - Essay Sample

Introduction

Merit-based Incentive Payment System (MIPS) is a system that mainly determines the Medicare payment adjustments. It uses a composite performance score, no payment adjustments, a payment penalty, or eligible clinicians may receive a payment bonus. The program has streamlined three independent systems to work as one, and they are value-based modifier (VBM), Physician quality reporting system (PQRS), and electronic health record incentive program/meaningful use (MU) (Boamah, Laschinger, Wong, & Clarke, 2018). Moreover, the system also adds another component improvement activities (AI), mainly to promote innovation and improvement. The new program s essential as it allows clinicians to choose measures and activities that are meaningful to the practice and ease clinician burden.

Is your time best spent reading someone else’s essay? Get a 100% original essay FROM A CERTIFIED WRITER!

Save 25%

MIPS on practices is mainly two-fold, which are reputational and financial. The financial include annual payments that are based on the composite performance score, while the reputational impact includes publications by CMS mainly on an array of clinician identifiable performance. The new policies under MIPS are providing more significant incentives to healthcare workers to participate in alternative payment methods. Consequently, the system brings about more strictness in bench markets for the providers to follow in improving the quality of healthcare in their organization (Boamah et al., 2018). Moreover, MIPS results in advances n healthcare reforms. The system has three primary systems physician quality reporting system, value-based payment modifier, meaningful use, and clinical practice improvement category.

Thirdly, the system focuses on value-based care cuts costs. This leads to a reduction in wasteful spending and procedures, as the service providers mainly focus on the quality instated of quantity. Resultantly, this leads to lower medical costs (Donaldson, Kelley, Dhingra-Kumar, Kieny, & Sheikh, 2017). These aspects are essential in the health service as the healthcare providers get reduction and un cost and ultimately leading to reduced medical cost and improved service delivery.

A Scientific Basis for The Proposal

The main focus and establishment were to reward clinicians who provided high-value care while penalizing clinicians who don not with lower adjustments. Clinicians can find this challenging as estimating their expected payment adjustments and make their choices regarding the appropriate participation track. Given the decision by Medicare to roll out MIPS with reduced CPS thresholds, the main concern with the program is that the system could generate a high number of higher performers across whom the payment might be spread therefore undercutting the participation incentives.

Moreover, because the QPP participation decision is mainly based on expectations and beliefs about performance and complexities in the MIPS payments system, this can create an important implication for the clinician's QPP participation decision (World Health Organization 2017). Primarily, the clinicians who are not high positive payment adjustments can opt-out of the system and enrolling in other more advanced APMs, which mainly requires participants to assume more financial risk, and it is governed by its own rules.

Forming the Team and Setting Aims

This is an essential step as it ensures that the projected achieves its objectives and aims. To obtain the goals, the team needs to be qualified and have the rights skills and capabilities to generate the required results (Boamah et al., 2018). Some of the qualities that the team will have include excellent communication skills, focus of the goals and outcomes, everyone makes their contribution, offer support to each other, the team members are diverse, organized, ability to have fun while performing the tasks, and ethical leadership (Graban, 2018).

Importantly, the team needs to understand why it has been formed and the expected goals. The aims of the group include:

• Identify areas in the MIPS where it needs adjustments.
• Identify is the program has been able to achieve its objective.
• Identify is the program is fair to all physicians.
• Put forwards recommendations t improve the system.

Establish Measures and Select Changes

The MIPS programs are essential in the healthcare setting, and it has played a crucial role in improving healthcare care system and improve the quality if the healthcare quality, efficiency, and patient safety. The main measurements that contribute to MIPS are cost, quality, clinical practice, and advancing care information. The aspects are essential in making sure that MIPS is successful (Donaldson et al., 2017). The cost of the healthcare system needs to be maintained at a level where each individual will be able to afford (Lynn, L. A., & Lynn, E. N. 2019). Making healthcare affordable will reduce the financial burden on most families, and those funds will be used on essential things such as education and housing.

Consequently, the quality of healthcare needs to be as high as possible. Despite making the cost of healthcare loss, it does not mean its quality should be reduced or lowered. The quality of healthcare service is essential in making sure that the MIPS meets its intended goals and objectives, and people receive the best service (Boamah et al., 2018). Consequently, efficiency is another important measure that needs to be considered in making sure the intended objectives are achieved (Panagioti et al., 2018). Productivity makes the quality of healthcare improvement and reduced the cost of healthcare. Advancing care information is another aspect which is a crucial measure.

Selecting the changes is another important aspect of making sure that the program is successful. It is essential to identify the systems in the program that are not working and improve them, and they include:

• Running a broad set of measures and identifying the one that performs the best.
• Comparing the performance.
• Capturing data from additional fields
• Capture free text data
• Using end to end electronic reporting processes

Analysis of Results

The information for the paper was mainly based on research that was primarily based on a literature review of other peer-reviewed journal articles (Graban, 2018). This was crucial as the information needs to from credible sources. The literature review was an essential aspect of the work as it needed to align with the requirement of the topic.

Conclusion

To sum up, MIPS is a program used to reward clinicians who offer the best services while at the same time giving a penalty to the clinicians who do not provide high-quality service. The program has streamlined three independent systems to work as one, and they are value-based modifier, physician quality reporting system, and electronic health record incentive program/meaningful use. The system has been crucial in reducing healthcare costs, improving healthcare quality, and increasing healthcare efficiency. The new policies under MIPS are providing more significant incentives to healthcare workers to participate in alternative payment methods. Consequently, the system brings about more strictness in bench markets for the providers to follow in improving the quality of healthcare in their organizations.

References

Boamah, S. A., Laschinger, H. K. S., Wong, C., & Clarke, S. (2018). Effect of transformational leadership on job satisfaction and patient safety outcomes. Nursing outlook, 66(2), 180-189.

Donaldson, L. J., Kelley, E. T., Dhingra-Kumar, N., Kieny, M. P., & Sheikh, A. (2017). Medication without harm: WHO's third global patient safety challenge. The Lancet, 389(10080), 1680-1681.

Graban, M. (2018). Lean hospitals: improving quality, patient safety, and employee engagement. Productivity Press.

Lynn, L. A., & Lynn, E. N. (2019). U.S. Patent No. 10,366,790. Washington, DC: U.S. Patent and Trademark Office.

Panagioti, M., Geraghty, K., Johnson, J., Zhou, A., Panagopoulou, E., Chew-Graham, C., ... &Esmail, A. (2018). Association between physician burnout and patient safety, professionalism, and patient satisfaction: a systematic review and meta-analysis. JAMA internal medicine, 178(10), 1317-1331.

World Health Organization. (2017). Patient safety: making health care safer (No. WHO/HIS/SDS/2017.11). World Health Organization.