July 15, 2020


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Since 2017, Medicare clinicians have participated in the Quality Payment Program (QPP), including the Merit-Based Incentive Payment System (MIPS), to earn annual payment increases by providing high quality care and taking financial responsibility for the cost of patient care. Recently, CMS issued more details about QPP and MIPS in a 2018 Quality Payment Program Experience Report. This report reinforces the strong performance of MIPS clinicians and gives insight into performance of smaller and rural providers.

In our recent whitepaper, The Effect of MACRA on Community Hospitals, Caravan’s founder Lynn Barr addresses how providers can better understand MACRA opportunities and use MIPS to improve patient care, generate revenue, and lower costs. By leveraging ACOs and Advanced APM bonuses, providers can earn considerably higher reimbursements using risk-based payment models. In one scenario, a 25,000-life medical center can increase its income up to $8 million through MIPS eligible dollars.

Download the whitepaper to learn more

The 2018 MIPS scores showed strong participation, excellent performance, and modest payment increases for the highest performers. Caravan Health ACOs averaged more than 99 points, and 24 of 36 Caravan ACOs achieved the maximum score of 100 points. This echoed the experience of the first MIPS year in 2017 which showed that our clients, many of which are smaller and rural providers, are able to successfully compete in MIPS.
The 2018 Experience Report dives deep into measure reporting for MIPS across three categories: Quality, Improvement Activities, and Promoting Interoperability. The data demonstrates the methods clinicians use to submit information and the measures most commonly reported. Of those, the ten most commonly reported quality measures had a 99%+ reporting rate and were mostly submitted via the web interface.

Clinicians earn payment adjustments based on clinician scores and the numbers of clinicians at each level of performance. For example, the maximum payment adjustment for the 2018 performance year was 1.68%. Very few clinicians – about 2% - earned a negative payment adjustment. That means 98% of all providers avoided a negative payment adjustment, and most of those earned an increase. The vast majority of clinician reporting MIPS through an alternative payment model (APM) participate in a Medicare Shared Savings Program ACO.

The report shows good news for rural and small practices. In 2018, 97% of rural practices and 84% of small practices earned a positive payment adjustment. This is an improvement from the previous year when 93% of rural practices and 74% of small practices earned positive adjustments. Of the 889,995 MIPS-eligible clinicians, 116,222 are counted as rural based on ZIP code, and 115,071 are considered to be small with 15 or fewer clinicians.

The Quality Payment Program and MIPS, along with an understanding of how to leverage MACRA, are keys to physicians maintaining their incomes throughout the coming years. By participating in a Caravan Health risk-bearing ACO, providers can be exempt from MIPS reporting and earn a 5% part B bonus. To learn more about joining a Caravan Health ACO for 2021 and successfully transitioning to risk, contact us at info@caravanhealth.com.

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