Female doctor typing on computer with stethoscope on desk.

CMS released details on July 7 about the second-year performance results of the Quality Payment Program’s (QPP) Merit-based Incentive Payment System (MIPS), which determined payment adjustments for clinicians in 2020. 

Here are five notes on MIPS scores and payment adjustments from the 2018 performance year: 

  1. Most clinicians in MIPS — 98 percent — avoided a negative payment adjustment in 2018. A year earlier, 5 percent of clinicians received a negative payment adjustment. 
  2. Most clinicians — 84 percent — earned an “exceptional performance” designation, resulting in positive payment adjustments ranging from 0.2 percent to 1.68 percent. 
  3. About 13 percent of clinicians in MIPS received payment adjustments of 0 percent to 0.2 percent. 
  4. More than 356,000 clinicians participated in MIPS through Advanced Alternative Payment Models in 2018, a 15,000 clinician increase from a year earlier. 
  5. In 2018, 84 percent of small practices and 97 percent of rural practices earned a positive payment adjustment. In 2017, 74 percent of small practices and 93 percent of rural practices received a positive payment adjustment. 

2019 Performance Year – 2021 Adjustment

  1. The performance threshold (i.e. the clinician’s reimbursement remains the same) is 30 points. A number of clinicians have adopted the strategy to at a minimum attain this performance threshold. This strategy avoids any reimbursement reduction and keeps their resource investment at a reasonable level.
  2. To attain the additional adjustment factor a clinician needs to attain greater than or equal to 75 points. The law states this could increase reimbursement from .5% to 10%. However, given the number of clinicians that qualify in this category, the actual increases are typically in the .5% to 1% range.
  3. Clinicians that earn 7.5 points or less can receive a reimbursement reduction of 7%.
  4. Category weights are as follows: quality 45%; cost 15%; promoting interoperability 25%; and improvement activities 15%.

Proposed 2020 Performance Year – 2022 Adjustment

  1. The performance threshold (i.e. the clinician’s reimbursement remains the same) is 45 points. A number of clinicians have adopted the strategy to at a minimum attain this performance threshold. This strategy avoids any reimbursement reduction and keeps their resource investment at a reasonable level.
  2. To attain the additional adjustment factor a  clinician needs to attain greater than or equal to 80 points. The law states this could increase reimbursement from .5% to 10%. However, given the number of clinicians that qualify in this category, the actual increases are typically in the .5% to 1% range.
  3. Clinicians that earn 10 points or less can receive a reimbursement reduction of 9%.
  4. Category weights are as follows: quality 40%; cost 20%; promoting interoperability 25%; and improvement activities 15%.

MIPS has helped clinicians to focus on improved quality, interoperability, improvement activities and cost-efficiency. Clinicians who attain the additional adjustment factor should be able to receive more than the historical .5% to 1% reimbursement increase. The next few years will see more clinicians moving towards value-based care and an opportunity to share in cost savings as they continue to improve quality services to patients.