The Real MIPS Timeline: 3 Stages of MACRA and MIPS

by | Nov 9, 2017 | MIPS

This morning when I googled “MIPS timeline” I got 174,000 results. There sure are lots of pretty charts and colorful graphs out there. Most of them will let you know when this will happen and when that will occur. When does the definition of Eligible Clinicians change? When does the Cost Category begin and how quickly will it escalate? Is there a deadline for forming Virtual Groups? You can go stir crazy trying to keep track of all the milestones.  At a micro level it is hard to separate the wheat from the chaff and decide what is important and what can be ignored. With your permission and indulgence I would like to introduce you to the “Jim Tate Macro MIPS Timeline”.

My timeline incorporates only 3 significant phases. Here they are:


  • Phase 1 – Denial: This period began January 1, 2017 and brought the onset of the first MACRA MIPS performance year. Eligible clinicians and affected organizations have one year to become educated and make decisions that will put them on the path of being a winner or a loser. Most will not be prepared and that will lead us to Phase 2.
  • Phase 2 – Shock/Anger: I anticipate this to take place in the 4th  Quarter 2018. This is the period in which the MIPS Comparison Performance Scores (based on 2017 actions) will be made public. I expect the first practice/provider level freak-out to occur immediately. Suddenly realizing you have a low public MIPS score that affects both reimbursement and professional reputation will be a shock. Expect to see a lot of finger pointing, outrage, and “this is not fair” commentary. As Mr. Bob Dylan said, “money doesn’t talk, it swears”.
  • Phase 3 – Acceptance: The impact of the public MIPS scores and the 4% Part B penalties that begin January 1, 2019 will bring realization that the MACRA MIPS program is real. Attention will be focused on the fact that by 2022 Part B reimbursement could vary as much as 18% or more. It will become obvious that those who provide Medicare B care will have to join this imperfect, but essentially mandatory, shift to pay-for-value.

There you have it. Phase 1 might as well be called “head in the sand”. Phase 2 will be the most dramatic as is it the predicable tipping point. Phase 3 will bring resolution.