What doctors need to know to get ready for MIPS


The Medicare Access and CHIP Reauthorization Act (MACRA) intends to move the healthcare industry toward value- and quality-based reimbursement, but in the short term physicians need to come to grips with the Merit-Based Incentive Payment System (MIPS), an article in Medscape suggests.

MACRA initially conceived of MIPS as an intermediary step toward Alternative Payment Models (APMs), says Anders Gilberg, senior vice president of government affairs for the Medical Group Management Association, but the proposed rule on the new payment system dumps the vast majority of practices into MIPS. Although the details around reporting metrics under MIPS remain uncertain while the Centers for Medicare & Medicaid Services (CMS) works with physicians to refine a final rule, practices can still prepare based upon what we already know about the law, says Stanley Nachimson, a Baltimore consultant who previously worked for CMS.

Here’s a synopsis:

  • MIPS scores clinicians under four categories, led by quality metrics that gauge performance based on clinical outcomes and account for half the overall score, according to the article. Advancing care information--an expanded, more flexible version of Meaningful Use--accounts for another quarter of the score, with the remainder tied to clinical practice improvement measures (15 percent) and resource use (10 percent).
  • Practices with high MIPS scores get bonus payments, while low-scoring practices get penalized. While some extra funds are available for bonuses, the system is predominately zero-sum, with penalties paying for most of the bonuses, according to the article.
  • CMS expects larger group practices to receive most of the bonuses, while smaller practices get penalized disproportionately. The upshot of all this will be “a widening gap between the haves and the have-nots,” says Jonathan Burroughs, M.D., a New Hampshire-based consultant.
  • Nevertheless, Burroughs believes it unlikely that MIPS will simply go away, and, in fact, he sees the program as part of an overall move toward the standardization of clinical practice.

To help individual and small group practices prepare for the new payment system, the Department of Health and Human Services earlier this week announced it will spend $100 million over the next five years to provide training and education targeted to those providers.

- here’s the article