What is MIPS? And Why Should I Care?

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We are surrounded by acronyms that are tossed around like candy on Halloween, and the worst part is that we are expected to know what they mean with little or no context. One of the worst offenders when it comes to use of acronyms is probably the healthcare industry, mostly because there is so much going on, and sometimes it is quicker to communicate with the use of acronyms. Some of these acronyms are inside jargon, while others are concepts that we should probably understand, especially with all the changes that have been going on within healthcare. One of them is the implementing of MACRA or Medicare Access and CHIPS Reauthorization act and MIPS or Merit-based Incentive Payment System. Lets start out by answering the question to: What is MIPS?

MIPS is one of two programs a healthcare organization can choose to work within. Slightly different requirements are set, however, MIPS is the broader choice, and will probably be where most organization elect to conform to. Overall, the premise is to consolidate already existing program standards, and to add another facet that will work together to not only simplify the already burdened healthcare system, but also to improve the care that patients are receiving. The four different features are:

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  • Quality Improvements – show markedly improved outcome statistics, including a reduction in readmissions after a traumatic or severe illness or injury
  • Use of Resources Improvement – show a noticeable difference in the way resources are utilized; as a way to eliminate wasteful allocation of time, resources and personnel
  • Clinical Practice and Activities Improvement – show a development of comprehensive clinical strategies and their effect within the organization
  • Improvement to Care Information – show an increased number of patients accessing information via patient portal or other online interface

Each improvement category is meant to change the face of healthcare and the way it is delivered because the old way of doing this is not what patients need, is not where technology is leading and is not going to get the job of helping patient to get better to truly be realized. This is exactly why MACRA has been implemented, to change the mentality of a fee-for-service, which is somewhat profitable for doctors, however can leave the patient jumping through hoops – in this case being subjected to many services – rather than getting healed as quickly as possible. MACRA reimburses healthcare organization based on a pay-for-performance or quality of service basis, which puts more emphasis and focus towards providing the best care, in the least amount of time, and with the fewest resources.

Many people may be wondering if this might mean cutting corners on the part of the care being offered; this shouldn’t be the case because in all of this patient satisfaction is tracked to make sure that he or she has a say as to how services are coming along. Another mitigating factor that hospitals, especially, must take into consideration is the readmissions rates and if there is an uptick in the number of patients that are returning to the hospital, there must be a lack of initial care or help once a patient has been discharged from the hospital.

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No one ever said that providing good quality care was going to be easy, or that there weren’t going to be changes asked of doctors and other healthcare professionals along the way. MIPS is simply a program that helps to lay out the new standards for organizations to follow, and the incentives or penalties associated with adhering or not to the program. The next time someone asks, “What is MIPS?”, you will be able to answer more succinctly, and with a better understanding as to what the healthcare industry goes through to provide better care