Most 2017 Participants in MIPS Qualified for Small Bonus

Kerry Dooley Young

November 09, 2018

The Centers for Medicare & Medicaid Services (CMS) said 93% of participants in the Merit-based Incentive Payment System (MIPS) under the Quality Payment Program earned positive ratings for their 2017 performance. The maximum gain for "exceptional performance" was 1.88%.

"Admittedly, the MIPS positive payment adjustments are modest," said CMS Administrator Seema Verma in an October 8 blog post. "It is important to remember that the funds available for positive payment adjustments are limited by the budget neutrality requirements" imposed by federal law.

Verma also noted that "2017 served as a transition year to help ease clinicians into the program and encourage robust participation.

"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.

The statistics in Verma's blog post suggest that many clinicians managed the new Medicare system for judging their performance fairly well in 2017. The overall national average score for MIPS-eligible clinicians was 74.01 points out of a possible 100 points. The national median score was 88.97 points.

In a snapshot chart, CMS showed that 71% of MIPS-eligible clinicians fell into the top-ranked category, with ratings of 70 to 100 points. That qualified them as having a rating that may allow for "additional adjustments for exceptional performance," CMS said. Payment adjustments for this group ranged from 0.28% to 1.88%, according to the chart.

Another 22% of clinicians fell into the second-ranked group, with ratings of 3.01 to 69.99 points, according to the CMS chart. Payment adjustments in this group range from 0.00% to 0.20%.

Only 2% of clinicians fell into the third-ranked group, which CMS described as a "neutral" rating for those having earned about 3 points. There will be no payment adjustment for this group.

In addition, 5% fell into what CMS termed the "negative" group, which includes those clinicians who earned 0 points. The possible payment reduction for this group is as much as a 4.0% reduction.

The results released Thursday reflected the performance of 1,057,824 participating eligible clinicians who will receive a MIPS payment adjustment, either positive, neutral, or negative.

In the 2017 results, clinicians working at institutions or groups that qualified for CMS' Alternative Payment Model (APM) program scored better than those working as solo practitioners or in groups.

The clinicians in the APM group received a mean score of 87.64 points and a median score of 91.67 points. Others had a mean score of 65.71 points and a median score of 83.04 points.

CMS intends to aid those who earned low MIPS ratings, Verma said.

"For clinicians with a negative payment adjustment, we pledge to work with you through our customized technical assistance," she said. "You can rely on this no-cost assistance to identify your needs, address potential barriers, and help you prepare to successfully participate in future years."

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