The data is in for the first year of the Merit-based Incentive Payment System (MIPS) under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and it shows that the vast majority of the clinicians who participated will receive a positive payment adjustment in 2019.
In fact, of the 1.06 million eligible clinicians who participated in MIPS in 2017, 93% will receive a bonus on each of their Medicare Part B claims beginning January 1, 2019. Around 5% of participating clinicians will receive a penalty on their claims, up to 4%, and two percent of physicians had neutral scores and won’t receive a bonus or a penalty.
Payment adjustments and whether the clinician will receive a bonus or a penalty was determined based on how well the clinician did in three different performance categories: quality, clinical practice improvement, and advancing care information through the use of health information technology. There is a fourth category – cost – but it was not used in determining payment adjustments in the first year.
Once the score is determined for how the clinician performed in the three categories, they are put into reward categories: those who scored between 70 and 100 points on all three categories (71% of MIPS participants) are eligible for a bonus between 0.28% and 1.88%; clinicians who scored between 3.01 and 69.9 points (22% of MIPS participants) are eligible for a bonus between 0.01% and 0.20%. Clinicians scoring 3 points or less on all three categories are not eligible for a bonus (nor a penalty). Those scoring zero points (5% of MIPS participants) will receive a penalty.
It is interesting to note that clinicians who work at an institution or group that qualified for CMS’ Alternative Payment Model (APM) program scored better than those working as solo practitioners or in groups. The clinicians in the APM group received a mean score of 87.64 points and a median score of 91.67 points. Others had a mean score of 65.71 points and a median score of 83.04 points.
Centers for Medicare and Medicaid (CMS) Administrator Seema Verma acknowledged the high rate of clinicians set to receive a bonus for their participation in Year 1, noting, “We expect that the gradual increases in the performance thresholds in future program years will create an evolving distribution of payment adjustments for high performing clinicians who continue to invest in improving quality and outcomes for beneficiaries.” She also acknowledged that “2017 served as a transition year to help ease clinicians into the program and encourage robust participation.”
For 2017 participation (Year 1), the overall performance threshold was 3 points. For the 2018 performance period, however, clinicians will have to score at least 15 points to receive a bonus and the cost category will be considered, accounting for 10% of the final point score in 2018.
CMS does plan to help those clinicians with low scores, Verma noted, saying, “For clinicians with a negative payment adjustment, we pledge to work with you through our customized technical assistance,” she said. “You can rely on this no-cost assistance to identify your needs, address potential barriers, and help you prepare to successfully participate in future years.”