arrow up


The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is intended to rapidly push the transformation of the US healthcare system toward performance-based payment models across both government and commercial payers. The law provides strong incentives to physicians for participation in Medicare risk-sharing Alternative Payment Models (APMs). For physicians who choose not to become involved in APMs, they will be required to report and perform well on four categories – quality, promoting interoperability, improvement activities and cost – in the new Merit-based Incentive Payment System (MIPS).

Bearing risk and reporting on clinical performance requires the ability to collect, analyze and report on clinical performance data. Whether it is identifying high cost patients, reducing readmissions and adverse events, coordinating care and managing resource use, or accurately reporting quality measures to various registries and payers, clinicians will need to make better use of health information technology to help them avoid financial penalties and allow their practices to prosper in the new environment.


Take the MIPS Quiz

Can you meet the following MIPS-related requirements?

    YES NO

1. Are you participating in a health information exchange?


2. Do you know who your high risk and rising risk patients are?


3. Are you gathering data from all of your patient’s providers to improve your quality scores?


4. Do you know your patient’s emergency department utilization?


5. Do you have strategies in place to reduce healthcare utilization for your patients?

Consider this:


Based upon the new Merit-based Incentive Payment System (MIPS), there is revenue to be gained or revenue at risk based upon how you perform. If, for example, you receive $200,000 in Medicare Reimbursement annually, the financial impact according to the MIPS schedule is as follows the first year:

KAMMCO provides you with the tools necessary to CONNECT. ANALYZE. ENGAGE. TRANSFORM.

MIPs is the new proposed payment program from CMS designed to streamline three already existing independent programs (quality, resource use and improvement activities) and combine them with a fourth program to promote improvement and innovation of clinical activities (Advancing Care Information). Clinicians have the flexibility to choose the activities and measures that are most meaningful to their practice and then demonstrate performance. Year one Composite Performance Score category weighting: Quality 60%, Advancing Care Information 25%, Improvement Activities 15%.

Quality Dashboards
Quality = 50% of MIPS Score

  • Influenza Immunization
  • Pneumococcal Vaccination
  • Osteoporosis Screening
  • Breast Cancer Screening
  • Diabetes A1c > 9
  • Colorectal Cancer Screening
  • Cervical Cancer Screening

Promoting Interoperability = 25% of MIPS Score

  • Secure Clinical Messaging/DIRECT
  • HIE Longitudinal Patient View
    • Within EHR
    • Web-based Access
  • ONC Certified Personal Health Record
    • View Download & Transmit (VDT)
    • Patient Education
    • Secure Messaging
  • Public Health Interfaces
    • Immunizations
    • Syndromic Surveillance
    • Diabetes Clinical Data Registry

Improvement Activities = 15% of MIPS Score


  • Participate in HIE
  • Participate in Research


  • Regular Reviews of Targeted Patients
  • Empanel Patients for Providers
  • Proactively Manage Patient Care
  • Identify High Risk Patients
  • Improve Health Status of Communities
  • Measure and Improve Quality


  • Patient Portal
  • Patient Education Materials

Cost = 10% of MIPS Score

HIE Access / Use of the Longitudinal Patient Record: Reduces duplicative services, helps to eliminate delays in the care process and facilitates patient safety for overall cost reduction.

Additional Resources

  • Access physician payment reform resources from the AMA
  • Access physician payment reform resources from CMS
  • Access MIPS Quiz document