2017 QPP Experience Report Shows ‘Significant’ Participation in MIPS

March 21, 2019

Christina Leone, MPA Clinical Quality Specialist

The Centers for Medicare and Medicaid Services (CMS) released the long-version of its 2017 Quality Payment Program (QPP) Experience Report, providing an in-depth overview of the Merit-based Incentive Payment System (MIPS) reporting experience from the first-year of the program.

Data shows both significant and highly positive participation and performance in MIPS for the 2017 performance year, which impacts 2019 Medicare payments. For 2017 reporting, eligible clinicians needed to achieve 3 or more points for their final MIPS score to avoid a negative payment adjustment. 95% of the 1,057,824 eligible clinicians achieved that goal:

Table Sourced from: CMS 2017 Quality Payment Program Reporting Experience

Group reporting was the preferred method of reporting. In fact, 54% of eligible clinicians received their final score based on group participation.

CMS marked 2017 as a “Test Your Pace” year. Participants could submit data for less than 90-days and still achieve a neutral payment adjustment. Those that submitted data for 90-days or more were eligible for positive payment adjustments and ‘exceptional performance’ bonus adjustments. Across all MIPS categories, CMS indicates that most eligible clinicians opted to participate for 90-days or longer. For the quality category, this trend was particularly noticeable, with approximately 75% reporting data for a full 12-months.

Encompass Quality Clients Received Positive Adjustments in 2019 for 2017 Reporting

CMS states that the highest positive payment adjustment received for 2017 reporting was +1.88% for 2019 payments. And, the average MIPS final score for 2017 was 74.01 out of a total 100 points available.  Encompass quality clients that participated in the Monitor Assess Prescribe Solutions (MAPS) monthly consultation program participated in 2017 MIPS reporting with resounding success. Clients opted to forego the “Test Pace” option and participate in a full-year of reporting. Encompass strategized with its clients to select quality measures that matched each group’s unique workflow and specialty needs and set the course on a strategy to maximize bonus potential.

Clients achieved success and received bonus payments up to the maximum +1.88% positive payment adjustment, with final MIPS scores ranging from 96.47 to 98.72 – far surpassing the national average score of 74.01. This means that Encompass quality clients will receive MIPS positive payment adjustments ranging from $334,000 to $580,000 for projected 2019 Medicare payments.

Reimbursement penalties for lack of participation in federal reporting programs will continue to rapidly increase. For 2019 reporting, impacting 2021 Medicare payments, eligible clinicians can face up to a -7% penalty for non-participation or for failure to participate adequately. Additionally, provider and practice reputations are at risk as the CMS continues to release quality metric performance ratings to the public via its Physician Compare website.

While there is much to lose in non-participation, there is also a lot of potential revenue up for grabs in the form of MIPS positive payment adjustments for physician groups that submit clinical quality data and show progress to improvement. Encompass can help to set a strategy not only for adequate participation in MIPS, but to maximize bonus potential – a win for your financial bottom line.

Download our 2019 MIPS Fact Sheet

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