3 ways to profit from merit-based incentive payments

The complexity of MIPS means lots of decision-making for practices looking to make the program profitable.

The Merit-based Incentive Payment System (MIPS) is complex, and the program has generated a lot of frustration among physicians. But practices that plan and implement the program carefully could realize near-term financial benefits.

Elizabeth Woodcock

As is typically the case with a complex program, the devil is in the details when it comes to MIPS, writes Elizabeth W. Woodcock, president of consulting firm Woodcock & Associates in Atlanta.

In addition to adjusting requirements exempting more than 800,000 physicians from participation in the MIPS program, CMS has also eased up on requirements for those in their first year of participation. And bonus incentives for exceptional performance will increase from 12% this year to 27% in 2022.


Elevate Health Plan Member Engagement Through Call Center Transformation

Learn how health plans can rapidly transform their call center operations and provide high-touch, concierge service to health plan members.

Woodcock, in an op-ed for Medscape, offers some tips for scoping out the landscape and getting the right plan in place, including:

  1. Determine if your practice is eligible. The lack of bonus incentive offers for ineligible practices means participation most likely isn’t worthwhile for those who don’t make the list. With additional ineligibility decisions coming in 2018 and continued pressure on CMS to address the burden of clinical reporting, those with borderline eligibility probably won’t see a payoff, either.
  2. Figure out the best way to report. CMS offers multiple options for reporting, each with their own pros and cons. Woodcock advises practices to be aware of what metrics they want to track, as not all registries or EHRs are capable of tracking all measures.
  3. Weigh the costs and benefits. Large payment amounts mean both higher penalties and higher potential bonuses. According to Woodcock, this is where the cost of compliance comes into play, especially in the first year. Reporting a single measure could save a 4% penalty, even if the cost of reporting to get to 70 points far outstrips the bonuses involved.

Suggested Articles

Nearly 10,000 patients involved in research studies were impacted by a third-party privacy breach that may have exposed their medical diagnoses, test results…

Employers looking to continue investing in their wellness programs are eyeing services targeting mental health and women’s health, a new survey shows.

Payers have made strides digitizing and automating many core processes, yet prior authorization remains a largely manual, cumbersome process.