Most providers succeed at MIPS but see small rewards in program’s first year

November 14, 2018
Medicare Web

Although most eligible clinicians who participated in the first reporting year of the Merit-based Incentive Payment System (MIPS) received a positive payment adjustment, even the highest performing clinicians saw only a modest bonus. The maximum positive payment adjustment was only 1.88%, Seema Verma, administrator of CMS, said in a blog post discussing the Quality Payment Program’s (QPP) 2017 performance results.

MIPS was launched in 2017 as one of two clinician participation tracks in the QPP. Under MIPS, CMS applies a positive or negative payment adjustment to the standard fee paid according to the Medicare Physician Fee Schedule. The adjustment is based on clinicians’ total MIPS performance score, calculated from the following four categories:

  • Advancing Care Information
  • Cost
  • Improvement Activities
  • Quality

Each category was assigned a weight toward the total MIPS score. For 2017, the Quality category accounted for 60% of the total MIPS score. These weights will change in future years.

Overall, the vast majority of eligible clinicians avoided a negative payment adjustment: 93% received a positive payment adjustment and 2% received a neutral payment adjustment. However, 5% of eligible clinicians fell short and received a negative payment adjustment of up to -4.00%.

The results show that eligible clinicians who were early adopters saw the greatest success, Verma said. She acknowledged that the positive payment adjustments were modest. The smaller bonuses are due in part to 2017 serving as a transition year, she said. CMS made an effort to ease eligible clinicians into the program with a lower performance threshold and flexible participation options that allowed eligible clinicians to choose to report only partial data.

However, gradual increases in the performance threshold, adjustments to the category weights, and mandatory reporting will narrow the pool of clinicians who receive positive payment adjustments, Verma added.

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