How to Profit From MIPS, Explained in Plain English

Elizabeth W. Woodcock, MBA, FACMPE, CPC


September 06, 2017

In This Article

Should You Bother to Participate in MIPS? Weigh the Factors

Given the challenges of the scoring methodology, it's an opportune time to step back and consider the big picture.

First, determine whether you're eligible for the program in the first place. Approximately one third of clinicians are ineligible. (CMS exempts eligible clinicians who did not see 100 Medicare patients during a reporting year or did not receive $30,000 in Medicare Part B total allowed charges.) If you're not eligible, don't participate, because you won't glean any reimbursement boosts.

The government has proposed excluding another third of clinicians as of 2018. If you're only borderline-eligible this year, and you'll be out next year, it's likely not worthwhile to invest in the QPP reporting infrastructure for just 1 year.

Next, dig into your management information system and pull your own data. Capture your performance for the quality measures you've considered for reporting. Stack them up against the measures to determine how many points you think you'll get. If the answer is not many, then it may be best to default to the simple single-measure reporting allowed in 2017.

If the data reveal that you're performing the measure—even if you didn't know you were—then it's an opportunity to construct a plan to reach the 70-point exceptional performance threshold.

Finally, it pays (literally) to find out what's at stake in the first place. If your Medicare payments were $40,000 last year, then the 4% penalty will result in a loss of $1600. You can mitigate that loss by just reporting one measure—"yes," for example, to timely test results reporting, which is one of the improvement activities.

On the flip side, what's to gain? Exceptional performance promises up to 12%, or $4800, in this case. A nice bonus, but one that you won't see until 2019 (because the "scoring" will occur over the next 24 months). But that would be a paltry return if your EHR system vendor charges you $20,000 for the upgrade required to report MIPS. Given the fact that you would probably be exempt in the program's second year, on the basis of the recent proposed rule, that $20,000 upgrade would border on foolishness.

In other words, take a step back to understand not only what your potential is for success, but also what's at stake financially.

Use this approach to gather the information you need for your practice to make a decision about QPP participation. Schedule a meeting with your partners to review the material you've gathered in order to determine your strategy.

This certainly isn't a plug for defaulting on reporting quality measures, but it's a strategy for taking a business approach to determine whether to participate pays.

If the QPP doesn't make sense for you, create your own program. That is, develop an approach to quality reporting that makes sense for you. When a payer negotiates a contract or makes a move to kick you out of the network, you'll have data to present to prove your value.

MIPS is not impossible to learn or succeed with, but it is much different from PQRS, despite some outward similarities. Keep in mind the important distinctions of the program—reporting methods, application to all patients, and scoring based on relative benchmarks—as well as your internal discoveries, to determine your best approach.


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