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    MIPS: How you will be measured going forward

    ‘Composite score’ incorporates quality performance, cost, EHR use, clinical practice improvement


    Pay adjustments will begin in 2019

    MIPS payment adjustments will begin in 2019, when the physician fee schedule is adjusted up or down based on 2017 MIPS composite score performance compared to the average: A clinician who is below average will receive a negative adjustment, and a clinician who is above average will receive a positive adjustment. The maximum adjustment is +/–4% in the first year, and this increases to +/–9% in subsequent years. Clinicians with exceptional performance are eligible for positive adjustments up to three times the maximum, and clinicians scoring under the 25% negative percentile receive the maximum negative adjustment (see table and figure).

    Read - Buy and bill: Know the nuances, save your margins

    CMS estimates that in urology, there will be more winners (clinicians with positive adjustments) than losers under MIPS in year 1.

    Bottom line: Absent any major legislative reform, MACRA is the law of the land and will be implemented and in effect by Jan. 1, 2017. The major theme is payment linked to quality and cost, and most urologists will start in MIPS. Urologists can begin to prepare now by reviewing their PQRS feedback reports and their annual QRUR for the most recent available year. In addition, practices should develop a strategy for monitoring performance on Quality Performance, Cost, Advancing Clinical Information, and Clinical Practice Improvement Activities now—and deciding whether it makes sense to report as individuals or as a group. Some additional investment in tracking mechanisms may be necessary to maximize reimbursement in the new world of MIPS.

    More from Urology Times:

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    Subscribe to Urology Times to get monthly news from the leading news source for urologists.

    Robert A. Dowling, MD
    Dr. Dowling is president of Dowling Medical Director Services, a private health care consulting firm specializing in quality ...


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