Vast majority of doctors will get a pay bump under MIPS—but it won't be much

Medicine Money
Few doctors got penalized in the first year of MIPS, but payment adjustments were low. (Getty/utah778)

Most doctors and other clinicians did OK in the first year of the Merit-based Incentive Payment System (MIPS).

More than 90% of the doctors and clinicians who participated in MIPS will receive a pay bump based on their performance in 2017, said CMS administrator Seema Verma in a blog post about the program implemented under MACRA in which clinicians receive either a positive, negative or neutral payment adjustment based on their performance.

However, it won't be much.

Even those with the highest performance scores only earned a 1.88% positive adjustment. That left many physicians disheartened.  At last month’s Medical Group Management annual conference, one official commented that those low MIPS payments left many physicians “feeling like it was just for nothing.”

RELATED: MGMA18—Underwhelming MIPS payments leave physicians ‘feeling like it was just for nothing’

Overall, 95% of participants avoided a negative payment adjustment, Verma said. That leaves only 5% of participants with a negative 4% payment adjustment. Here’s an additional breakdown:
  • 71% earned a positive adjustment and an adjustment for exceptional performance and received a 1.88% adjustment
  • 22% earned a positive payment adjustment only and received a .20% adjustment
  • 2% received a neutral adjustment (no increase or decrease)
  • 5% received a negative payment adjustment, a -4% adjustment

The additional data released by CMS shows “significant success” of the program, Verma said. “These results demonstrate that clinicians who engaged early and meaningfully participated experienced success,” she said.

To give doctors time to adjust to the new system, the Centers for Medicare & Medicaid Services (CMS) set the bar low in the first year, offering a “pick your pace” option with minimal participation to avoid a negative payment. And physician groups urged doctors to report one measure for one patient, to avoid the negative payment. However, with just 5% of participants taking a negative adjustment, there was little money to fund incentive payments to others.

More than 1.57 million MIPS eligible clinicians will receive a payment adjustment—either positive, neutral or negative, Verma said. Of those, just over $1 million reported data as either an individual, as part of a group, or through an alternative payment model (APM) and received a neutral payment adjustment or better.

Additionally, under the second track offered under MACRA—the Advanced APM—just over 99,000 clinicians earned qualifying APM participant (QP) status, she said.

Verma also addressed the low payment adjustments “Admittedly, the MIPS positive payment adjustments are modest,” she said. “It is important to remember that the funds available for positive payment adjustments are limited by the budget neutrality requirements in MIPS, as established by law under [MACRA].”

With 2017 serving as a transition year, the overall performance threshold for MIPS was set at a relatively low level of three points and the availability of “pick your pace” provided flexibility through three reporting options for clinicians: submission of a single measure, reporting for a partial year or full-year reporting.

“This measured approach allowed more clinicians to successfully participate, which led to many clinicians exceeding the performance threshold and a wider distribution of positive payment adjustments,” Verma said.

“We expect that the gradual increases in the performance thresholds in future program years will create an evolving distribution of payment adjustments for high performing clinicians who continue to invest in improving quality and outcomes for beneficiaries,” she said.

For those clinicians with a negative payment adjustment, Verma said CMS will provide customized technical assistance to help them succeed in future year.

CMS just released a final rule that outlined requirements for year three of MIPS. One group, the AMGA, a trade association that supports the shift to value-based payments, voiced concerns that the rule continued to allow for high exclusion thresholds in the MIPS program.

The AMGA said the thresholds are intended to transition providers into the program, but instead serve to undermine the efforts of high-performing providers already participating in the program.

Under the final rule, clinicians or groups can be excluded from MIPS if they meet one of more of the following three criteria: They must have $90,000 or less in Part B allowed charges for covered professional services; provide care to 200 or less Part B enrolled beneficiaries; or provide 200 or less covered professional services under the Physician Fee Schedule.

However, more clinicians will be covered by MIPS in the third year of the program, including physical therapists, occupational therapists, qualified speech-language pathologists, qualified audiologists, clinical psychologists and registered dietitians or nutrition professionals.

Also starting next year, clinicians or groups can opt-in to voluntarily participate in MIPS, if they meet or exceed at least one, but not all three, of the low-volume threshold criteria.

“We’re puzzled by CMS’ decision to continue to exempt providers from MIPS. On one hand, CMS is speeding toward value-based care by accelerating the transition to risk-bearing models in the Medicare Shared Savings Program,” said AMGA President and CEO Jerry Penso, M.D. “At the same time, CMS is excusing other providers from having to consider moving toward value at all. It’s disappointing and seems to be at odds with CMS’ stated goals regarding value-based payment.”

To provide information about changes to MIPS, CMS released a fact sheet (PDF) outlining changes to its quality payment program under MACRA and an executive summary (PDF) with further details.