The Centers for Medicare & Medicaid Services (CMS) recently announced that 98.4 percent of eligible clinicians participated in the second year (2018) of Merit-based Incentive Payment System (MIPS) reporting — and that 97.6 percent of those earned a positive payment adjustment.
While the initial successes of 2018 and 2017 sound impressive, there’s a hard truth going forward: MIPS reporting just got a lot more difficult for physicians and other providers in 2019 and promises to get even more difficult in 2020.
The agency has increased the performance threshold for “positive financial adjustment” and the threshold for “exceptional” performers has been raised from 70 to 75, meaning physicians will have to do more to earn the designation of top performers. The negative penalty threshold, meanwhile, has doubled from 15 points to 30 points.
On the plus side, CMS is doing more to help small practices through the new bonus programs and resources. But in order to succeed and avoid penalties, physicians will need to do more than just show up.
Addressing MIPS challenges
One of the biggest challenges we’ve seen so far is that physicians aren’t always sure how to align MIPS with their existing workflows to meet CMS’ Triple Aim Goals of improving health, reducing costs and improving the experience of care. Figuring out how to do this without the proper guidance, tools and insights creates unnecessary redundancies and work.
Also, for many physicians, the mere onset of MIPS has stirred resentment. To some physicians, some of the measures feel unattainable, such as the measure that requires getting patients with high blood pressure to reach a target blood pressure of 140/90 or better.
But with the right support structures and guidance, physicians can easily avoid the negative 7 percent reduction in Medicare reimbursement and maximize MIPS success.
MIPS tips and tricks
Practices that want to earn positive payment adjustment in the years ahead should adopt the following MIPS reporting strategies used by practices that enjoyed exceptional performer status in 2018:
1. Determine eligibility and target quality measures
Set your practice up for a win by first checking MIPS-eligibility status through the QPP Participation Status Tool (qpp.cms.gov). Next, target the most appropriate or relevant quality measures. For 2019 reporting, CMS asks practices to report on six measures, or a complete specialty measure set, including one outcome measure. Select at least 10 measures to track throughout the year so your practice has options for choosing the top six quality measures. For now, avoid the quality-based performance metrics, since they could be difficult to perform well enough to quality for incentivized payments. Instead, reduce reporting inefficiencies by aligning with target metrics for other quality improvement initiatives. For example, if your practice has a high population of patients with hypertension or COPD, achieving optimal blood pressure averages for the group is a priority goal.