Does MIPS Reduce The Cost Of Care In Rural Hospitals?

Is MIPS The Answer For Rural Hospitals?

Hospital costs are one of the biggest levers determining the facility’s long-term survival and success. Rising insurance costs often negatively affect these hospitals. On the other hand, value and quality of care matter to patients. To meet in the middle, the Center for Medicare and Medicaid Services (CMS) formed a quality payment program (QPP) to incentivize clinicians. One way to participate is the merit-based incentive payment system (MIPS), established in 2017. MIPS consolidates several different reporting mechanisms into one rated report. The CMS then rewards high performance with Medicare adjustments. MIPS can prove helpful in hospitals, especially those in rural areas.

MIPS requirements

Any clinician who bills for Medicare part B must perform MIPS submissions, with some exceptions. These include individual practitioners, virtual clinics, and hospitals. In addition, some hospitals provide data as a group. Exemptions include those with a low volume billed in Medicare per year or newly enrolled in Medicare. Clinicians in other payment models are also exempt from participating. Exempted practitioners can participate voluntarily but will not be eligible for payment incentives. The medical practitioner virtually submits data on the hospital’s performance. CMS then provides a final score.

How is MIPS measured?

MIPS uses a 100-point value scale weighted in order of quality, cost, interoperability, and improvement activities. The data covers all these factors, with some minor exceptions. The final score will decide a MIPS payment adjustment. The result can determine a positive payment, neutral adjustment, or a penalty. Any incentives earned are deducted in the subsequent year. CMS rewards any score over 75 on an increasing scale. A 75 score means no payment, while a score less than 75 means a negative adjustment.

Can MIPS help rural hospitals?

MIPS is not mandatory in cases where there is a low submission of Medicare claims. However, rural hospitals that do qualify should consider submitting data. Most will find that MIPS can significantly improve the cost of care. Most residents of small towns and communities depend on insurance to cover medical expenses. A high MIPS score means that rural hospitals can recoup hundreds of thousands of dollars yearly. Processing these claims and navigating payment issues also cost rural hospitals administrative fees. MIPS allows hospitals to slash these costs.

Maintain a high level of service

To qualify for incentive payments, the facility must earn high quality and cost savings scores. Therefore, the hospital must be efficient while providing excellent care to patients. Submitting the data helps hospitals to notice gaps in care. From there, the rural facility can establish a clear plan to improve service delivery. These changes may include optimizing case management, speeding up throughput, or investing in technology. As a result, the cost of care will decrease through MIPS payments and through more efficient performance.

Get ready for MIPS

Rural hospitals can benefit from a program that helps larger institutions. MIPS helps hospitals be more accountable and incentivizes excellent performance. Smaller hospitals in these communities can reduce the cost of care with high scores. Over time, the hospital will save even more money through exceptional service.