More Clinicians Get MIPS Positive Payment Adjustments in Year 2, CMS Reports

Ninety-eight percent of clinicians participating in MIPS (the Merit-based Incentive Payment System) will receive a positive payment adjustment this year for their program performance in 2018.

CMS officials released the 2018 MIPS performance year data this week, noting that more clinicians will receive positive payment adjustments than in 2017, which was the first performance year of the program. This is a 5 point increase over the 2017 performance year, CMS officials pointed out, and that’s with an overall positive performance threshold for MIPS increase from 3 points in 2017 to 15 points in 2018, they added.

MACRA’s (the Medicare Access and CHIP Reauthorization Act of 2015) Quality Payment Program (QPP) includes two payment paths that eligible Medicare-participating physicians could partake in—MIPS and the advanced alternative payment models (APM) track. While the MIPS path involves more data reporting on the part of doctors, it comes with less risk for losing money; for each reporting year of the program, eligible clinicians are given a MIPS score which determines their Medicare payment adjustments two calendar years later.

Nearly, 900,000 clinicians—889,995 to be exact—received a MIPS payment adjustment, either positive, neutral, or negative. Out of that population, 98 percent of MIPS eligible clinicians will receive a neutral payment adjustment or better through their individual, group or APM participation. This is compared to 95 percent who avoided a negative payment adjustment last year.

What’s more, 97 percent of eligible clinicians in rural practices will receive a positive payment adjustment, compared to 93 percent in 2017. For small practices, 84 percent of eligible clinicians received a positive payment adjustment, an increase from 74 percent in 2017, according to CMS.

Federal officials pointed out that given the structure of the program, “Positive payment adjustment will remain modest in part because, under the MACRA law, the positive and negative payment adjustments must be budget neutral. This means that the funds available for positive payment adjustments are limited to the estimated decrease in payments resulting from the negative payment adjustments. But because the thresholds have been lower, many providers have qualified. As the program matures, we expect that the increases in the performance thresholds in future program years will create a smaller distribution of positive payment adjustments for high performing clinicians who continue to invest in improving quality and outcomes for beneficiaries and positive adjustments will increase.”

However, CMS continued, “it’s also important to note that Congress provided $500 million for the first six years of the law to fund additional adjustments for exceptional performance. These adjustments are not budget neutral, allowing exceptional performers to achieve higher positive adjustments.”

The 2018 data also revealed that 183,306 eligible clinicians earned Qualifying APM Participant (QP) status under the advanced APM path while another 47 eligible clinicians received partial QP status during 2018.

Indeed, more clinicians are earning QP status, CMS touted. In 2017, the number of eligible clinicians who met QP status was 99,076 and partial QP status was 52. “The increase in advanced APM participation in 2018 reflects an increase in clinicians who provide high quality and cost-efficient care while moving towards value-based payments through advanced APM participation,” CMS stated.

Starting next year, in 2021, MIPS will transition into a new program, called MIPS Value Pathways (MVPs), as part of CMS’ 2020 Physician Fee Schedule final rule that aims to transform the MIPS program into one that engages clinicians and specialty societies, to craft measures that assess them on what matters most— outcomes, according to federal officials. CMS stated, “While our MVP framework becomes effective in 2021, we’re still committed to implementing the current version of MIPS.”

According to CMS in that final rule released in November, “This new framework, the MIPS Value Pathways, will be developed in collaboration with stakeholders such as medical professional societies and will begin in the 2021 performance period. It moves MIPS from its current state, which requires clinicians to report on many measures and activities across the multiple performance categories, which consist of Quality, Cost, Promoting Interoperability, and Improvement Activities, to a program that allows clinicians to pick which clinically-related, specialty-specific measurement sets to report on that are more relevant to their scope of practice.”