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93% of MIPS Eligible Clinicians Will Receive a Positive MIPS Payment Adjustment in 2019

November 13, 2018

McDermott+Consulting

On November 8, 2018, the Centers for Medicare and Medicaid Services (CMS) announced that 93 percent of Merit-based Incentive Payment System (MIPS) eligible clinicians will receive a positive MIPS payment adjustment in 2019 based on their performance in 2017. Overall, 95 percent of eligible clinicians avoided a negative payment adjustment. The chart below summarizes the results.

Positive payment adjustment
+
Exceptional performance adjustment
Positive payment adjustmentNeutral payment adjustmentNegative payment adjustment
71% 22%2%5%

2019 is the first year of MIPS payment adjustment. While the statute allows for payment adjustments of +/-4 percent (with an additional exceptional performer bonus and scaling factor of 3.0 that could have resulted in a bonus as high as 22 percent), the actual payment adjustments will range from -4 percent to + 1.88 percent. The top positive adjustment includes the exceptional performance adjustment that applies to the top 25 percent of performers.

This modest positive adjustment is partly a result of how CMS designed the program for 2017. The 2017 Performance Year, Year 1 of MIPS, was considered a transition year and CMS set a low bar to avoid a negative adjustment – clinicians only needed to submit a single measure. This performance threshold created a large pool of clinicians earning a positive or neutral payment adjustment. Because MIPS is a budget neutral program, meaning negative adjustments must be balanced by positive adjustments, the top positive payment adjustment was reduced to less than the maximum amount allowed by statute.

Other key findings released by CMS include:

  • The overall national mean (or average) score for MIPS eligible clinicians was 74.01 points, and the national median was 88.97 points
  • Clinicians participating in an MIPS Alternative Payment Model (APM) did better than those who were not participating in such models
    • Clinicians participating in MIPS as individuals or groups (and not through an APM) received a mean score of 65.71 points and a median score of 83.04 points
    • Clinicians participating in MIPS through an APM received a mean score of 87.64 points and a median score of 91.67 points
  • On average, MIPS eligible clinicians in rural practices earned a mean score of 63.08 points, while clinicians in small practices received a mean score of 43.46 points

For a complete breakdown of 2017 performance data click here and an infographic of the results is available here.

More information on the QPP, MIPS and Advanced APMs is available on the CMS QPP website.

 


For more information visit the McDermottPlus Payment Innovation Resource Center or contact Sheila Madhani at 202-204-1459 or smadhani@mcdermottplus.com.

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