The overwhelming majority of clinicians who participated in the first year of the Merit-based Incentive Payment System under MACRA will receive a positive payment adjustment in 2019, the CMS announced Thursday.
Of the 1.06 million eligible clinicians who participated in MIPS in 2017, 93% will receive a bonus on each of their Medicare Part B claims beginning Jan. 1, 2019. About 5% of clinicians will receive a penalty as high as 4% on their claims. Two percent of physicians had neutral scores and won't receive a penalty or a bonus.
The payment adjustments were determined by how well the clinicians scored in three performance categories: quality, clinical practice improvement and "advancing care information" through use of health information technology. The fourth category — cost — wasn't applied in the first year so it didn't affect payment adjustments.
Clinicians who scored between 70 to 100 points on all three categories—or 71% of MIPS participants—are eligible for a bonus as high as 1.88% to as low as 0.28%. For the 22% of clinicians who scored between 3.01 to 69.9 points, they can get a bonus as high as 0.20% and as low as 0.01%. The 2% of clinicians who didn't receive a penalty or a bonus only scored 3 points on MIPS. The 5% of clinicians who got a penalty scored 0 points.
The majority of clinicians were likely able to receive a bonus because the overall performance threshold was 3 points, CMS Administrator Seema Verma said in an emailed statement.
"We expect that the gradual increases in the performance thresholds in future program years will create an evolving distribution of payment adjustments for high performing clinicians who continue to invest in improving quality and outcomes for beneficiaries," she said.
For the 2018 MIPS performance period, clinicians have to score at least 15 points to receive a bonus. The cost category will also account for 10% of the final score in 2018.
In reaction to the MIPS results, AMGA took issue with the CMS' exclusion criteria. Clinicians enrolled in Medicare for the first time, bill less than $90,000 in Medicare revenue or have fewer than 200 unique Medicare patients per year were exempt from MIPS. The same criteria applies for the second year of the program.
"Continuing to exempt a significant percentage of providers from the program undermines the ability of those physicians and group practices who are working hard to deliver care under MIPS to earn a meaningful payment adjustment," said Darryl Drevna, director of regulatory and public policy at AMGA.
Verma pointed out that clinicians in small, rural practices performed well in the first year of MIPS. Rural providers earned a mean score of 63.08 points.
"While we understand that challenges remain for clinicians in small practices, these results suggest that these clinicians and those in rural practices can successfully participate in the program," Verma said.