CMS’ Seema Verma says MIPS exceeded participation goal in first year

Eligible clinicians who didn't participate in MIPS face a 4% reduction in Medicare reimbursement. (Valeriya)

A sheer 91% of all clinicians eligible under the Merit-based Incentive Payment System (MIPS) participated in the first year of the program.

That slightly exceeded the Centers for Medicare & Medicaid Services goal of 90% participation, CMS Administrator Seema Verma said in a blog post.

Even so, thousands of physicians and clinicians will face penalties for not participating in the first year of the new physician payment system. Eligible clinicians who did not participate will face a 4% cut in their Medicare reimbursement.


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Submission rates for Accountable Care Organizations and clinicians in rural practices were even higher, at 98% and 94% respectively, Verma said. 

“What makes these numbers most exciting is the concerted efforts by clinicians, professional associations and many others to ensure high-quality care and improved outcomes for patients,” Verma wrote in the blog post.

RELATED: MIPS—Find out if you are in or out for 2018

In 2017, clinicians—including physicians, physician assistants, nurse practitioners, clinical nurse specialists and certified nurse practitioners—had to participate in MIPS if they billed Medicare Part B more than $30,000 a year and saw more than 100 Medicare patients a year.

The second year of MIPS and its quality reporting requirements started Jan. 1. While fewer clinicians will need to participate under a reduced threshold, CMS has upped the ante, requiring clinicians to report quality data for a full 365 days, rather than the 90 days last year.

In April, 49 physician groups, which represent hundreds of thousands of doctors, sent a letter to CMS asking  it to reduce the reporting period for MIPS this year from a full year to a minimum of 90 days. The groups requested the change because CMS did not post information about which doctors must participate under MIPS until April 6.

RELATED: Doctors’ groups ask CMS to cut MIPS reporting period for this year

In the blog post, Verma said CMS is committed to reducing the regulatory burden for clinicians, including advancing its "Patients over Paperwork" initiative.

“Even with this high rate of participation, we are committed to removing more of the regulatory burdens that get in the way of doctors and other clinicians spending time with their patients,” she wrote.

Changes to MIPS requirements in 2018 will continue to reduce burden, add flexibility and help clinicians spend less time on unnecessary requirements and more time with patients, she said. In particular, she cited four changes: 

  • Reducing the number of clinicians required to participate, “giving them more time with their patients, not computers.” To reduce the burden on small practices, CMS changed the threshold to exclude clinicians and groups if they billed $90,000 or less in Medicare Part B allowed charges and furnished services to 200 or fewer beneficiaries.
  • Adding new bonus points for clinicians who are in small practices, treat complex patients or use 2015 Edition Certified Electronic Health Record Technology to promote the interoperability.
  • Increasing the opportunity for clinicians to earn a positive payment adjustment.
  • Continuing to offer free technical assistance to clinicians in the program.

Verma said CMS can use the statutory authority provided under the Bipartisan Budget Act of 2018 to continue a gradual implementation of requirements for three more years to further reduce burden under MIPS.

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