MIPS: Payment — Not Penalty. How to Raise CPS with EHR

MIPS: Payment — Not Penalty. How to Raise CPS with EHR

dr_EHR / September 18, 2016

The prospect of “performance scores” has raised questions among ENT physicians. Every independent practitioner has concerns about the Merit-based Incentive Payment System, aka, MIPS, and how it will affect Medicare reimbursements.

Your Composite Performance Score (CPS) will determine whether you get financial rewards – or penalties.

You can earn significant financial rewards for providing excellent patient care under this MIPS plan. You can also be penalized.

Download Guide 2: Don’t Let MACRA MIPS You in the Butt

MIPS prototype discussed at AAO annual meeting

A pilot program for the MIPS reward system appears to have been tested at the Annual American Academy of Otolaryngology-Head and Neck Surgery meeting in Arkansas. The session focused on the new financial realities hitting healthcare.

Two payment models were discussed – including an “episode of care” model used in Arkansas which rewards or penalizes physicians based on how their expenses (per procedure/per time period) compare to an average. That model is very similar to the MIPS plan

Composite Performance Score (CPS)

MIPS provides small inflationary adjustments, but the incentives and penalties tied with the CPS adjustments are more substantial.

Every ENT physician’s performance is ranked according to specific measures. Every CPS point translates directly into higher or lower reimbursement.

These CPS scores allow Medicare clinicians to be paid for providing high-quality, efficient care through success in four performance categories:

  • Quality – 50% of your CPS score
  • Advancing Care Information/Meaningful Use – 25%
  • Clinical practice improvement activities– 15%
  • Cost/Resource use – 10%

The CPS earned by a clinician for a given performance year then determines MIPS payment adjustments in the next calendar year.

The Good, The Bad, and The Potential

If a clinician earns a CPS of 100 points, the reward is +4%. An additional “exceptional performance bonus” escalates up to +10%. An excellent CPS number will yield 4% + 10% = +14%. An ENT physician with excellent CPS numbers could accrue incentives reaching 37% of Medicare Part B payments by the fourth year of the program.

However, if a clinician has a CPS of zero, the penalty assessed is -4%, the maximum penalty. Maximum penalties can grow to -9%.

How will CPS scoring affect you?

It’s expected that very few eligible clinicians will get a zero payment adjustment. Each ENT physician’s CPS number will now be made public, so this new level of transparency will likely push clinicians to achieve high CPS numbers right out of the gate.

The best way for ENT physicians to prepare for MIPS is to start participating in the Physician Quality Reporting System (PQRS) and Meaningful Use programs this year or be prepared to do so in 2017, the first MIPS reporting period.

Reporting quality measures through participation in a registry — using an EHR system that meets Meaningful Use standards — is an excellent way to insure successful MIPS reporting and participation.

Watch for MIPS updates

At this printing, MIPS is scheduled to take effect January 1, 2017. The department of Health and Human Services has until November 1, 2016 to publish the quality measures. However, what you’ve just read is the most recent and accurate information we’ve gathered to date.