The results are in! We now know how providers will be rewarded for their 2017 MIPS efforts. You may be disappointed to see that with a perfect score of 100, the 2019 payment adjustment will max out at just slightly above 2%. And, unless a provider exceeded the exceptional performance threshold, thereby qualifying for a share of the $500 million bonus pool, the reward for successful MIPS performance is no more than an approximately 0.3% positive payment adjustment.
A survey of a few SRS Health customers revealed the following correlations between scores and payment adjustments:
To summarize, MIPS Medicare payment adjustments fall into the following categories:
So what happened to the 4% positive payment adjustment “carrot” that the MACRA legislation appeared to offer (even before the bonus)? It vanished when CMS eased the requirements and reduced the threshold for penalty avoidance. Under the mandate of budget neutrality, with fewer providers receiving negative payment adjustments, there will be less money to share among the many providers who merit positive payment adjustments.
This was not unexpected, and a similar result should be anticipated for the next few years. The 2020 payment year (2018 performance year), offers a carrot of 5%, which will be similarly elusive. And the challenge of how to sufficiently motivate and reward providers will continue over the next few years, now that Congress has extended the transition period and relaxed the previously aggressive timetable for increasing the performance threshold.
Note: To find out your individual or group’s 2017 final score and precise payment adjustment, log in to the QPP portal and follow the “QPP Performance” prompt. Your final score will likely be what you expected based on your attestation and/or other submission(s). If there is a difference, it could be due to new information reflected in the Quality component of your score, for example:
- If, based on sufficient volume, you were subject to the All Cause Hospital Readmission measure, that data would be included in both the numerator and denominator of your Quality score.
- If one of your CQMs was CAHPS for MIPS, that score will now be reflected.
- If you reported a CQM for which no historical benchmark had been available at the time of submission, a benchmark may have been created subsequently, based on 2017 performance data.
If you believe that there is an error in CMS’ calculation of your final score—and therefore your payment adjustment—you can request a “Targeted Review” by September 30, 2018.