The MIPS Impact on a Medical Practice – Financial and Reputation – AssuranceMD

Part 2:  Previously we shared the MIPS changes for Quality Payment Program Year 2 and introduced AssuranceMD MIPS Success as a Service.  Although CMS raised the performance bar in 2018, AssuranceMD has the experts to help you develop your MIPS reporting strategy for 2018.

This week we cover the financial and reputational impact of MIPS on your practice. Most of the MIPS focus is on financial penalties and bonuses related to the program. But you also have to address the reputational impact to your practice as CMS makes each provider’s MIPS data publicly available.

From the financial perspective it is critical to understand MIPS is a budget-neutral program. As performance across all participating providers improves, CMS will raise the performance threshold (PT) to ensure bonus payments continue to be offset by financial penalties. Stronger performers will benefit at the expense of those with low scores, or that did not submit data.

How will you be scored?

CMS will assign each clinician a MIPS Composite Performance Score (CPS) between 0 and 100 based on performance across four MIPS categories. CMS will compare each clinician’s CPS to the performance threshold and those scoring above the threshold will receive bonuses. Those below the PT will be subject to penalty.

MIPS Year 2 reporting will determine up to a 5% bonus or penalty on 2020 Medicare Part B payments. The impact increases to +/- 7% in 2021 and +/- 9% in 2022. There are opportunities for high performers to receive additional payment adjustments – up to 27% in 2022. AssuranceMD MIPS Success as a Service will not only develop a 2018 submission strategy and plan to achieve 2020 bonus payments, but also ensure your practice is preparing for opportunities in 2021 and beyond.

Optimize Provider Reputation

The reputational impact of MIPS makes it even more important for you to understand where you stand today against benchmarks, as well as what changes you can make to have the most impact on your performance, quality of care and MIPS score.  CMS included “performance transparency” in the Quality Payment Program, and within approximately 12 months after the end of a performance period CMS will publish each provider’s MIPS score and component category scores on the Physician Compare website. This level of transparency and specificity goes beyond the existing PQRS and Value Based Modifier (VBM) programs. PQRS and VBM calculate quality and resource use scores but do not publicly publish the results.

As consumers/patients become more engaged in selecting providers, MIPS scores will play a larger role in their decision process. And employers and other payers will use MIPS performance data to identify partners in rapidly narrowing networks. Ultimately, a declining reputation in the market driven by publicly available MIPS scores will have a larger negative financial impact on your practice than the Medicare Part B financial penalties.

What to know and how to prepare

AssuranceMD MIPS Success as a Service will protect you from CMS penalties and help your practice not only survive but thrive in the quality payment environment. Please contact us for more information on how our experts partner with you to develop your 2018 MIPS strategies and plans.

Click the button below to receive our weekly MIPS Success as a Service communication strategy.