Financial impacts of MIPS and how to stay clear from them

MIPS is just around the corner and if you are one of the many clinicians preparing for it, this article can prove to be very helpful for you. Although prominent portals such as EMRSystems have come forward with MIPS Resource Centers that can help struggling clinicians go through the tough areas of the new rules, but this post is specifically for those who are wondering about the financial impacts of the new rules and how to avoid them.

Clinicians participating in MIPS face two types of financial impacts:

1. MIPS value-based payment adjustments (incentives or penalties) based on the MIPS 100-point final score

2. A minor, yearly inflationary adjustment to the Part B fee schedule

The minor inflationary adjustment is an annual +0.5 percent rise for the payment years 2016 to 2019. It is also the first payment year for MIPS under the QPP. The inflationary adjustment continues in 2026 and from then on MIPS eligible clinicians will receive a +0.25% annual adjustment.

Interestingly the potential MIPS incentives and penalties through value-based payment adjustments are quite substantial than these inflationary adjustments, so let’s focus on them as they will be the ones affecting you most. The table below shows the maximum positive or negative % Medicare Part B payment adjustment you can end up with.

Financial Impacts of MIPS

To ease the transition for the 2017 performance year, CMS has offered varying extents for medical organizations to either participate in or be exempt from MIPS. Here is a summary of the options provided:

No participation: Clinicians not exempt from MIPS who refrain from sending any data in 2017 will receive a negative 4% payment adjustment.

Reporting one measure for 90 days (minimum): Reporting only one ACI, CPIA or Quality measure will get you enough MIPS points to avoid a penalty. They can even lead you to win a small incentive if all things are done accordingly.

Reporting <1 measure for 90 days (minimum): Clinicians reporting more than one measure in Quality, CPIA or ACI categories can not only avoid a penalty, but can also maximize their MIPS score, and earn the highest possible incentive.

Participate in one of Advanced APMs: Organizations that can participate in an Advanced APM are exempted from MIPS and can earn a 5% Part B bonus.