MIPS, or the Merit-based Incentive Payment System, is a part of the big shift from the fee-for-service model to the Value Based Medicine model for medical reimbursements. It’s how MACRA will actually play out practically for your bottom line. In January of 2017, the government will begin measuring doctors’ effectiveness in giving patients quality care while lowering costs using four main criteria: quality (currently PQRS measurements), the advancing care initiative (currently Meaningful Use), clinical quality improvements, and cost relative to your peers. The composite score will then be used with MIPS to define your Medicare reimbursements.
That means that, in 2019, your Medicare reimbursements could potentially receive a bonus, remain flat, or be penalized. This will be determined through your composite scores using data that begins in 2017. If you score well, getting above a set threshold and doing better than your peers, you could potentially have your reimbursements adjusted with a bonus of up to a 4% increase (this will go up to a potential 9% increase by 2022 and beyond). If you score around the threshold, your reimbursement pay will not be adjusted and will remain flat. If you score too far below the threshold, your reimbursements will be adjusted with penalties that could be as much as 4% (but will increase to up to 9% by 2022 and beyond).
If this sounds overwhelming, don’t give into fear. While this definitely presents a challenge to doctors, the key is to think of it as a business decision for your practice. You have to determine how much it costs for you to comply versus how much it will affect your reimbursements. You don’t have to face this decision alone, though. Top Practices is partnering with Collaborative Practice Solutions to provide you with guidance and management coaching through our Virtual Practice Management Institute (VPMI). Don’t get caught by MIPS unprepared when you don’t have to. Contact us for more information about VPMI and getting started today by calling (717) 725-2679 or e-mailing [email protected].