The budget-neutral component of the payment adjustment will range from maximum negative of -5% to maximum positive of +5%.
Full penalty of -5% is applicable. According to the MACRA final rule, full penalty determined for the performance year applies if the score is at or below ¼th of the Performance Threshold for that year (15 x ¼ = 3.75). This is the only number that can be claimed with certainty.
Negative payment adjustment gradually decreasing on a linear sliding scale from -5% to < 0% will apply
Payment adjustment of 0%
Providers will receive the budget-neutral component of positive payment adjustment which is scaled from 0% to 5% (scaled to provide maximum adjustment at MIPS score of 100). A scaling factor (up to a max of 3) will be used to equitably distribute every single cent of the penalties collected. It means that there is a potential to earn a up to 15% (5% x 3 = 15) in budget neutral component of positive adjustment, provided there is enough money collected as penalties.
Budget-Neutral + Exceptional Performance Payment Adjustment
The providers whose score lie in this range will not only earn the budget-neutral payment adjustment, but will also earn an additional exceptional performance positive payment adjustment. This bonus will be given out from $500 million annual budget starting at +0.5% for MIPS score of 70, up to a max of +10% for a MIPS score of 100. Another scaling factor will be utilized to ensure a fair distribution of the monies, i.e. more money for a higher score and stay within the annual budget of $500 million.
CMS estimates the median performance to go up to 70s. This increase in average score would most likely reduce the percentage of payment adjustment that was available for a similar score for 2017 performance year. The estimated payment adjustment could be less than 5%. CMS will be in a position to give better estimates after the end of reporting period and calculation of MIPS scores for PY 2017.
Very soon, MIPS Score would mean much more than penalty avoidance and earning exceptional performance bonus. It would become every eligible healthcare provider’s REPORT CARD. According to CMS, MIPS scores for performance year 2017 will be published and made publicly available on the Physician Compare website by Fall 2018. Additionally, similar to the PQRS program, the performance on the quality measures reported by each TIN would be avaialbe for viewing too. These scores will most likely be used by other physician ranking websites such as Healthgrades. In the longer run, higher score would afford clinicians higher bargaining power in multiple situations. For instance:
- For mergers, acquisitions, and sale of practices
- For clinician recruitment
- For negotiating fee with healthcare insurance companies or to be on their preferred provider list
- As a decision making tool for provider selection - If one needed healthcare services, they can make their decision based on the provider’s MIPS score.
Although you can’t control what percentage you would earn for positive payment adjustments, you can definitely take charge of your MIPS Score and be proactive about it.