MIPS: The Latest Urban Legend?

We have all heard them, the urban legends. Giant alligators in the sewers of New York City. The woman who put her poodle in the microwave to dry it off after a bath. And my personal favorite, the Vanishing Hitchhiker. Who doesn’t like to hear a good story about cockroaches in a bouffant hairdo? We know they aren’t true but we like them anyway. What harm can it be to hear and pass on these morbid tales that bring such delight? No harm at all. However, in the world of healthcare reimbursement, one such fable making the rounds is not so harmless. However, in the world of MACRA/MIPS and Part B Medicare reimbursement, one such fable making the rounds is not so harmless. Here, for your consideration and review, is one that needs to be squashed as soon as possible.

The Rumor

“This whole MACRA/MIPS thing is no big deal. We made it through Meaningful Use with a wink and a nod and this will be the same. Nothing to worry about. Just keeping doing business the same way and all will be well. Hey, you can just put out little effort and then ignore the whole thing. Nothing to see here, just move along.”

The Truth

Very easy to debunk this nefarious yarn. In the short run, for performance year 2017, CMS says you can avoid penalties in 2019 by submitting “one quality measure or one improvement activity for any point in 2017”. That sounds good except, you will then have an initial MIPS score of 3 while your competitor across town has a score of 83. Since the MIPS scores will be public I’ll let you decide if that is a good business decision. Longer term, when MIPS is in full swing the Part B reimbursement adjustments begin at +/- 4% and quickly move within a few years to +/- 9%. That is a 18% swing. If you have $100,000 in Part B charges that would equate to $91,000 vs. $109,000 and we are not even talking about the bonuses for the highest-ranking providers.

There you have it. Money and reputation are at stake like never before. Myth dispelled. Now go and tell no more fables.