In 2017, 91 percent of eligible physicians and other clinicians submitted for Medicare reimbursement under the Merit-based Incentive Payment System (MIPS) for the first time. You may be one of them unless you don’t have Medicare patients or are participating in an advanced alternative payment model (APM). And on July 1, you might have immediately looked up your final MIPS performance score and feedback, let out a sigh of relief and gone about your day.
For other practices, this wasn’t necessarily the scenario. Best case: They may have needed a reminder about how to review their final results by logging into the same CMS Quality Payment Program website with the enterprise identity management (EIDM) credentials used to submit 2017 performance data. Worst case: When they saw their data, the news might not have been as good as expected. A number of factors could have impacted the feedback since the April preliminary score, so many providers may not have let out a sigh of relief, but one of frustration.
Whether you’re thrilled or dismayed with your final result, there’s still time to maximize your quality improvement (QI) efforts and improve your 2018 MIPS scores for Medicare payments you’ll receive in 2020.
The impact by then could be considerable to your financial outlook. As a reminder, your 2017 MIPS score determines whether you receive up to a 4 percent positive or negative adjustment to your 2019 baseline rates. In coming years, that incentive/disincentive grows more rapidly: +/- 5 percent for 2018 data impacting your 2020 revenues, jumping to +/- 7 percent for 2019 data/2021 reimbursement, and a whopping +/- 9 percent for 2020 data applied to you in 2022 and beyond.
For 2020 alone, that means a practice earning $1 million in Medicare reimbursements could earn up to $50,000 more. A similar practice could also lose that amount of reimbursement. The number jumps to $70,000 in 2021 and $90,000 in 2022. Depending on your Medicare volume, that financial effect could determine whether your practice succeeds or fails in just a few years.
Avoiding a penalty vs. building a foundation
Though MIPS was designed to make things simpler for providers by bringing together QI and cost containment programs, it has made data gathering and reporting more complex and more impactful to your bottom line. This can be especially challenging when you’re already up to your stethoscope serving an expanding aging population with multiple chronic conditions.
Considering the challenges as well as opportunities with this program, some practices have chosen to take a direct approach to MIPS and simply meet the baseline to avoid a penalty. Others have found MIPS to be an exceptional foundation for an overall QI program that can affect patients of all ages, and they’re happy not to leave earned money on the table. These practices keep the Triple Aim (quality, cost and patient experience) in mind as they develop a plan for the 2018 MIPS submission process.
As you review your final MIPS score and feedback, ask yourself: Are you trying to just avoid the penalty, or do you want to build a foundation for your practice’s success?
Exceptional performance in MIPS and long-term quality strategy
Ramping up your MIPS-related initiatives should also have a major impact on your patients’ health. For example, a Southeast-based academic medical center with nearly 1,000 multi-specialty providers embraced MIPS as part of its focus on the Triple Aim and a larger quality strategy to become an accountable care organization (ACO). Through the MIPS submission process, the team wanted to develop a long-term plan that would continue to improve how they cared for patients and how they were perceived as a quality care provider. This includes determining which core competencies to focus their efforts on, how they capture data and translate quality codes, and how often they could capture this necessary data for measuring and reporting results.