Patient Portal and MIPS

MACRA is the new payment model for Medicare and MIPS is the MACRA option that will apply to most providers.  Do they understand the impact using a Patient Portal will have on MIPS and therefore Medicare reimbursements?

The new Medicare payment model MACRA is set to take effect January 1, 2017 and impact 2019 reimbursements by up to a positive or negative 12%.  Unless a provider is an ACO or similar organization, they will fall under the MIPS option of MACRA.

Anyone who has researched MIPS realizes it is complicated.  There are 4 parts, a total of 100 points and lots of options and calculations for each of the 4 parts.  However, there are some items, such as use of a Patient Portal that cross multiple parts and make utilizing it a no brainer.  For example:

The 4 parts of MIPS and Patient Portal:

Part 1 Resource Use/Cost (10%):

  • No direct correlation to Patient Portal
  • However, a recent Tulane/Ohio State study found that improved doctor patient communications are linked to reduced readmissions

Part 2 Quality Reports (50%):

  • Bonus points are available for Patient Experience surveys which may be delivered through a Patient Portal
  • Results on many items under the patient’s control (such as Hemoglobin A1C under control) can be improved through patient reminders and patient education delivered via the portal.

Part 3 Advancing Care/EHR (25%):

  • Base Score (50% of the total) REQUIRES the participation of at least 1 patient in Portal activities such as accessing their information, receiving patient education, and messaging.
  • One-Half of the Performance Measure (the remaining 50%) is based on patient engagement activities through the Portal.

Part 4 Clinical Practice Improvement (15%):

  • 60 Points are available and you can be awarded 20 points for each High activity weighted High and 10 point for each Medium.
  • Many of the activities include communication and coordination with patients and their families which can be facilitated by using a Patient Portal.
  • Two Medium activities specifically address use of a Patient Portal:
    • Proactive management of chronic conditions and prevention care (under Population Management)
    • Providing access to an enhanced Patient Portal (under Beneficiary Engagement)

Visit https://naacos.com/news/TableH.pdf for a complete list of the proposed activities


The name of the game with MIPS is performing better than your peers.  The EHR portion alone (25% of your score) is heavily weighted to the Patient Portal.  Points in other areas can be achieved via use of a Patient Portal and/or use of a portal for communication and reminders is likely to enhance results.
Next week we’ll share tips on getting patients to use your Patient Portal.