December 05, 2018

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Caravan Health Average Scores is 93.2 points vs Standard Medicare Average of 65.7

This Fall, CMS released the latest Merit-Based Incentive Payment System (MIPS) information for 2017, the first year of the Quality Payment Program. While some results were made available earlier this year, this latest news provides a fuller picture of Medicare provider performance across the program. We were pleased to see that Caravan Health ACOs are again leading the pack in Medicare. 

Overall Medicare Results are Good

Most Medicare clinicians are scoring well in the new performance and payment system. CMS reports that 93 percent of MIPS eligible clinicians earned a positive payment adjustment in 2017. 71 percent earned both a positive payment adjustment and an adjustment for exceptional performance. At the same time, 2 percent received a neutral adjustment and 5 percent were subject to a negative adjustment.  

CMS points out that the payment adjustments are modest since the amounts are limited by law. For this first year, CMS treated it as a transition year and providers were able to choose from three reporting options (“test”, partial year, or full year) designed to encourage clinicians to participate. As the program matures, the scores and payment adjustments are likely to shift. Notably, CMS projected in MIPS rulemaking this year that the maximum MIPS adjustment would increase to 5 percent in 2019. 

Caravan Health ACOs Score 40 Percent Higher than Medicare Average
 

The new information underscores the great news we announced earlier this year about Caravan Health ACO MIPS scores. After review by CMS of Promoting Interoperability scores for a few of our ACOs, our Caravan Health MIPS average increased to 93.2 from 92.3 points– our scores are more than 40 percent higher than the standard Medicare average outside of Alternative Payment Models (APMs). The average upward payment adjustment for our ACOs of over 1.5 percent is just a shade below the maximum adjustment of 1.88 percent.
 
2017 MIPS Results Summary
Overall Medicare Average 74.0
Standard (Non-APM) Average 65.7
Caravan ACO Average 93.2
What’s to Come for MIPS?

MIPS scores are likely to evolve considerably in the coming years. For this first year, MIPS scores are high, with providers receiving relatively small positive payment adjustments. As MIPS is fully implemented, providers not participating in ACOs or other APMs may struggle to keep up, as more of the score is based on cost. In the future, more non-APM MIPS participants could be contributing the penalties that pay for APM rewards, creating a greater pay disparity among Medicare providers for those unable to benefit from the preferential scoring ACOs receive in the MIPS formula. 

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