For the third year in a row, Caravan Health ACOs scored near the top of all health care providers in the Merit-based Incentive Payment System (MIPS), CMS’s value-based measurement program that adjusts Medicare rates based on health care quality and outcomes. In results released last week, Caravan ACOs earned an average of 95 out of 100 points for the 2019 performance year. These outstanding scores mean that Caravan’s clinicians will be paid an average additional 1.45% for all professional services during the 2021 payment year. The majority of our partners, in our top six performing ACOs, earned adjustments between 1.51% and 1.79% for payment year 2021.
Sign up for our newsletter
“Once again, our ACOs are excelling at MIPS through the Caravan Health methodology,” said Tim Gronniger, Caravan Health CEO. “The bar for MIPS achievement rises every year and our focus on care quality, cutting edge technology, and patient engagement ensures that our partners are well-prepared. Even in the midst of the COVID-19 pandemic, our ACOs fully reported MIPS measures and should be congratulated for their dedication.”
All Caravan ACOs scored well above the 75-point threshold for exceptional performance for performance year 2019 and all were qualified for bonuses for treating patients with complex health needs based on overall medical complexity and social risk as measured by HCC risk score and Medicare-Medicaid dual eligible status.
MIPS continues to evolve in its third year, in part due the COVID-19 public health emergency. In the first months of 2020, when clinicians were reporting for 2019, CMS applied the extreme and uncontrollable circumstances policy due to potential hardships during the pandemic. This policy allows for reweighting of certain MIPS categories, allowing clinicians to focus on safety and COVID-19 response without being penalized with a negative adjustment.
MIPS payment adjustments have been modest in the first three years of the program but are set to increase in importance quickly over the coming years. Only 30 points were required to earn a positive adjustment in 2019. CMS recently proposed a performance threshold of 50 points for performance year 2021, the final year of the phase-in flexibility. With the increase of the threshold to mean or median score, as well as end to certain COVID-19-related exemptions in future years, we expect to see those achieving high scores receive much higher payment adjustments - for example, CMS predicts a maximum adjustment of over 7 percent for the 2021 performance year.