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MIPS: Payment — Not Penalty. How to Raise CPS with EHR

The prospect of “performance scores” has raised questions among independent physicians. Every practitioner has concerns about the Merit-based Incentive Payment System, aka, MIPS, and how it will affect Medicare reimbursements.

Your Composite Performance Score (CPS) will determine whether you get financial rewards – or penalties.

You can earn significant financial rewards for providing excellent patient care under this MIPS plan. You can also be penalized.

Composite Performance Score (CPS)

MIPS provides small inflationary adjustments, but the incentives and penalties tied with the CPS adjustments are more substantial.

Every physician’s performance is ranked according to specific measures. Every CPS point translates directly into higher or lower reimbursement.

These CPS scores allow Medicare clinicians to be paid for providing high-quality, efficient care through success in four performance categories:

  • Quality – 50% of your CPS score
  • Advancing Care Information/Meaningful Use – 25%
  • Clinical practice improvement activities– 15%
  • Cost/Resource use – 10%

The CPS earned by a clinician for a given performance year then determines MIPS payment adjustments in the next calendar year.

The Good, The Bad, and The Potential

If a clinician earns a CPS of 100 points, the reward is +4%. An additional “exceptional performance bonus” escalates up to +10%. An excellent CPS number will yield 4% + 10% = +14%. An ENT physician with excellent CPS numbers could accrue incentives reaching 37% of Medicare Part B payments by the fourth year of the program.

However, if a clinician has a CPS of zero, the penalty assessed is -4%, the maximum penalty. Maximum penalties can grow to -9%.

How will CPS scoring affect you?

It’s expected that very few eligible clinicians will get a zero payment adjustment. Each physician’s CPS number will now be made public, so this new level of transparency will likely push clinicians to achieve high CPS numbers right out of the gate.

The best way for physicians to prepare for MIPS is to start participating in the Physician Quality ReportingSystem (PQRS) and Meaningful Use programs this year or be prepared to do so in 2017, the first MIPS reporting period.

Reporting quality is measured through participation in a registry. Using an EHR system that meets Meaningful Use standards is an excellent way to ensure accurate and successful MIPS reporting and participation.

Watch for MIPS updates

At this printing, MIPS is scheduled to take effect January 1, 2017. The department of Health and Human Services has until November 1, 2016 to publish the quality measures. However, what you’ve just read is the most recent and accurate information we’ve gathered to date.  

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