The Centers for Medicare & Medicaid Services (CMS) administers the Merit-based Incentive Payment System (MIPS), under which MIPS-eligible providers receive a “final score” based on their performance on four measures (quality, cost, promoting interoperability and improvement activities). Their score is compared to a performance threshold, following which, providers receive a negative, neutral, or positive payment adjustment applied to future Medicare payments.

The U.S. Government Accountability Office (GOA) analyzed MIPS data from 2017 to 2019 and reported its findings. GAO also interviewed officials from CMS and 11 selected professional organizations that represent MIPS-eligible providers of various specialties.

Report Highlights

  • Final scores were generally high and at least 93% of providers earned a small positive adjustment, with the largest payment adjustment in any year being 1.88%.
  • Median final scores were well above the performance threshold across each of the 3 years.
  • 72-84% of providers earned an exceptional performance bonus, depending on the year.
  • 2 out of 11 stakeholders stated that bonus points, such as those that may be added to the final scores for small practices, helped increase scores for certain providers who might otherwise be disadvantaged.
  • 8 out of 11 stakeholders questioned whether the program helps to meaningfully improve quality of care or patient health outcomes.

According to CMS, the MIPS Value Pathways (MVP) – a new way of meeting reporting requirements in 2023 – will help to address some of these challenges by standardizing performance measurement across specific specialties, medical conditions, or episodes of care.

Source: U.S. Centers for Medicare & Medicaid Services (CMS)

 

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