The MIPS disappointment: Why physicians should consider alternatives

October 22, 2019

Is membership medicine a better choice?

After just two years, it appears the jig is up for CMS and the Merit-based Incentive Payment System (MIPS). MIPS is now expecting to pay out just 1.68% in bonus dollars next year to those doctors who achieved a perfect score.  This is down from last year’s payout of 1.88%.  It is no wonder doctors are disappointed!

As every doctor knows, reporting takes precious time and resources. For the promise of a financial bonus, many physicians have put in all the extra effort that MIPS requires and then some. But after all that hard work, to cross the finish line with a perfect score and receive such a small reward makes it all seem pointless.  “Pay per Value” versus “Fee for Service” sounds good in theory-but if you aren’t going to actually be paid for value, perhaps it’s time to consider new options.

Doctors work hard and they deserve to be paid for their efforts. While they may not be able to protect their practices from the pressure of value-based payment schemes like MIPS, they can look into other proven and predictable ways to support their practice and their patients.

Doctors who want to be reimbursed properly and in a timely way for the value, service and support they provide should look into the many styles of membership medicine available today.  These programs are much different than the concierge medicine programs of the past, which mainly transformed the practices of primary care doctors in affluent neighborhoods.   Today’s models support a wide variety of physicians including specialists and doctors who are part of large health systems.  They vary in their scope and application, providing either a helping hand, a much needed crutch, or the backbone of a medical practice-depending on the doctor’s needs and goals.  And the programs are compatible with Medicare, so there is no issue with MIPS or any value-based government program you may be working with.

The new crop of membership medicine models allow doctors to continue to treat all of their patients and accept Medicare and even commercial insurances, if they want to.  The programs supplement the support and service the patients already receive with more time, connectivity and medical advocacy.  The kind of services that aren’t reimbursable through insurance or Medicare, but mean a lot to the peace of mind of vulnerable patients.  

Perhaps most importantly, unlike MIPS bonuses, results from membership medicine programs are fairly predictable. When physicians enlist the support of experienced professionals, their practice will be analyzed carefully and reviewed against data accumulated from years of practice transitions to project an accurate level of success.  The doctor will know how many members to expect, where to set the membership fee, and which style program would result in the highest revenue or, for some doctors, the best balance between pace and revenue.    

And, instead of working hard today to secure an unknown financial bonuses next year, physicians earn predictable new revenue in real time, doing what they love to do each day: caring for patients. 

CMS appears to be sticking with MIPS, with penalties increasing next year and in the coming years for physicians who fail to meet their standards, and the promise of bonuses increasing for high-performing physicians.  Bonuses actually decreased from their modest levels last year, so these increases do not seem promising.  Unfortunately, there isn’t too much physicians can do regarding MIPS.  Participation is mandatory and physician quality scores are public.  But rather than just working hard, and waiting and hoping for the best, consider introducing a proven practice model to support your practice with the additional revenue MIPS can only promise.

Wayne Lipton is managing partner of Concierge Choice Physicians.