MIPS: Performance Results Are In

The Centers for Medicare & Medicaid Services (CMS) announced the 2018 Quality Payment Program (QPP) performance results for the Merit-based Incentive Payment System (MIPS) program. MIPS is the quality-based program for providers who are reimbursed largely through fee-for-service, as opposed to an Advanced Alternative Payment Model (APM) track which includes risk-based accountable care organization (ACO) models.

Only 2% of participating providers will receive a negative payment adjustment and 98% will receive positive payment adjustment in 2020. While this is good news, the quality performance threshold for positive adjustment was set relatively low (15 points) for this year, and payments are likewise low, with 13% of participating providers receiving 0% to 0.2% payment adjustment and 84% receiving 0.21% to 1.68% payment adjustment. Negative payment adjustments range from −0.01% to −5% for 2% of participating providers.

CMS also reported an increase in the number of participants in MIPS and double the number of providers in APM in 2018.

For the 2020 reporting year, penalties will increase to −9% and the quality performance threshold will be raised to 45 points to avoid these negative penalties, making MIPS more difficult. In addition, changes to which measures providers will need to report through the MIPS Value Pathways (MVPs) are set to begin in 2021. MVPs will bundle measures across categories based on specialties or medical conditions and reduce the overall number of measures upon which providers will need to report. Manufacturers should examine their prescriber groups’ applicable reporting measures to determine how best to support reporting of measures or provide feedback to CMS on measures.

Health Policy Weekly is written by Xcenda, a consultancy and business unit of AmerisourceBergen Specialty Group. Visit Xcenda’s online archive to access more health policy news.

To subscribe to Health Policy Weekly click here.