Most MIPS-Eligible Clinicians to Get a Medicare Pay Bump

Ken Terry

January 07, 2020

Nearly all eligible clinicians participating in Medicare's Merit-Based Incentive Payment System (MIPS) will receive positive or no payment adjustments in 2020, based on their 2018 performance, according to a blog post by Seema Verma, administrator of the Centers for Medicare and Medicaid Services (CMS).

In 2018, the eligible clinicians included physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists. Among the clinicians who were ineligible were providers who billed less than $90,000 in covered professional services and those who cared for 200 or fewer Medicare beneficiaries.

Verma said that 98% of eligible clinicians who participated in MIPS in 2018 will receive a "modest" bonus this year compared with 93% last year. Ninety-seven percent of eligible clinicians in rural practices will see a bump in their pay compared with 93% in 2019. Among eligible clinicians in small practices, 84% will receive a positive payment adjustment, an increase from the 74% who qualified for the increase last year.

Overall, Verma noted, 889,995 eligible clinicians will receive a MIPS payment adjustment, positive, neutral, or negative. Within that population, 872,148 eligible clinicians will receive a neutral or positive payment adjustment.

Eighty-four percent of MIPS-eligible clinicians will receive an additional bonus for "exceptional performance," meaning their performance score was equal to or greater than 70 out of 100 points. This is important because, under law, positive and negative payment adjustments must be budget-neutral, Verma explained.

Because few clinicians will have negative adjustments, the positive ones will be very small. To incentivize clinicians to do better, however, Congress provided $500 million during the first 6 years of the law for exceptional performance. So the eligible clinicians with higher scores will get an extra payment.

Alternative Payment Models

In 2018, 183,306 eligible clinicians participated in one of the qualified Alternative Payment Models (APMs) of the Quality Payment Program (QPP). In comparison, 99,076 eligible clinicians belonged to qualified APMs in 2017. These clinicians are exempt from MIPS and receive 5% bonus payments for 5 years. Yet only about 17% of all eligible clinicians in QPP joined one of these models in 2018.

Qualified APMs include Bundled Payments for Care Improvement, Comprehensive Primary Care Plus, the Medicare Accountable Care Organization (ACO) Track 1+ Model, the Medicare Shared Savings Program (Tracks 2 and 3 and two other tracks), the Next Generation ACO Model, and the Comprehensive Care for Joint Replacement Payment Model, among other programs.

Verma hinted at future changes in MIPS performance criteria that may change the distribution of positive and negative payment adjustments. "As the program matures," she said, "we expect that the increases in the performance thresholds in future program years will create a smaller distribution of positive payment adjustments for high performing clinicians who continue to invest in improving quality and outcomes for beneficiaries, and positive adjustments will increase."

As for the clinicians who will receive pay cuts from Medicare this year, she said, "We are committed to supporting these clinicians to reduce reporting complexity and burden, encourage meaningful participation, and improve patient outcomes. We are also fully committed to providing technical assistance to solo practitioners, small practices and clinicians in rural areas through our no-cost Small, Underserved, and Rural Support initiative."

Verma also noted that CMS has finalized its new MIPS Value Pathways, which will go into effect in 2021, as reported by Medscape Medical News. Under this program, CMS will reduce MIPS reporting requirements.

Eligible clinicians "will report on a smaller set of measures that are specialty-specific, outcome-based, and more closely aligned to Alternative Payment Models," CMS said in August when it announced the initiative.

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