How will MIPS Impact Your Practice?

The earth is rumbling with MIPS on the horizon. What changes can you expect in your practice? How will the Merit-Based Incentive Payment System, aka MIPS, affect your day-to-day life?

In the new MIPS environment, the way you provide patient care will have to change – at least, that’s true for most physicians.

MIPS is focused on improving patient care – bringing value and quality of care into the forefront. Through MIPS, you can prove you’re providing high-quality, efficient care. By doing so, you will be rewarded (financially) for your efforts.

Healthcare technology is still in the picture, but with a shift in focus. More about that further down.

MIPS 3 Big Goals

Better care, smarter spending and healthier people – those are the overarching goals for MIPS. For physicians, this translates as an emphasis on:

  1. Physician performance metrics (with financial incentives for providing high-quality patient care)
  2. New Medicare reimbursement formula
  3. Information-sharing of patient records via EHR systems

In this structure, MIPS links fee-for-service payments with quality and value – not on quantity, and not on simply having an EHR system. EHR technology slips into a supportive role for patient care, with an emphasis on better-connected systems.

One physician’s EHR system should be able to communicate with another clinician’s system. Patient records should be transferrable – so that patients can receive optimal care wherever they are in their travels. If they see another doctor, the flow of patient records should be seamless.

A patient’s medical record should be immediately known to every physician he or she sees. When a patient travels or relocates, a new physician should have access to those the electronic records.

Ending the SGR component of the payment formula

With MIPS, the Medicare reimbursement structure is changing. The Sustainable Growth Rate (SGR) formula has been booted out. New arrival is a value-based reimbursement system called the Quality Payment Program (QPP).

The QPP has two tracks: MIPS and the Advanced Alternative Payment Models (Advanced APMs). In 2019, clinicians must choose between the two – with MIPS offering attractive financial incentives.

MIPS offers new rewards system

Physicians will have two rewards for participating in MIPS:

  1. A small, annual inflationary adjustment to the Part B fee schedule. The inflationary adjustment is an annual 0.5% increase (until 2019). 
  2. Payment adjustments (incentives) based on the MIPS 100-point scoring system.

The MIPS “Quality Improvement” Plan

MIPS is all about improving quality in patient care – which translates into physician performance metrics. Every Medicare Part B physician will achieve a single Composite Performance Score (CPS) based on four categories:

  • Quality (50%)
  • Advancing Care Information (ACI, renamed from Meaningful Use) (25%)
  • Clinical Practice Improvement Activities (CPIA) (15%)
  • Resource Use (10%)

The physician’s CPS will determine the incentive earned (your financial reward) – or the financial penalty.  

MIPS Incentives & Penalties

The Good News: If a clinician earns a CPS of 100 points, then the incentive is 4%. There is an additional “exceptional performance bonus” that escalates up to 10% for progressively higher performers within the top ~30%. This is for the top 75% of those earning an incentive.

The Bad News: If a clinician has a CPS of zero, the penalty assessed is 4%, the maximum penalty.

Bottom Line: Every ranking in between is possible. The top-to-bottom MIPS potential impact on Part B payments for 2017 is likely to be from a 14% incentive down to a -4% penalty, or a total 18% top-to-bottom swing.

MIPS scores go public

That’s right, CMS will release each clinician’s annual CPS performance to the public.

For the first time, consumers will be able to see their providers rated on a scale of 0 to 100. They will see how their providers compare to peers nationally. We have not seen this level of transparency before. It goes beyond existing programs such as VBM (Value-Based Modifier) which calculates quality and resource use scores -- but does not publicly show the results.

Don’t panic!

The MIPS incentives are a lot to digest, and may feel intimidating. Don’t panic, as we’ll lay out steps you can take now to prepare for 2017. You have time to focus on all the changes, and we’ll help you lay out a game plan to do so.