MIPS: Heed the Undertow

by | Sep 14, 2018 | MIPS

Wikipedia defines undertow as “the under-current which is moving offshore when waves are approaching the shore.” The eye is deceived by focusing on the waves coming in and does not see the strong counter current ready to catch you by surprise. The danger is in the unexpected and unseen element. What does this have to do with MIPS?

The MIPS scores based on 2017 reporting periods have been calculated. For now, only providers have access to their scores. It is easy to do. Sign in at the QPP website and you can view your final MIPS score as well as relevant payment adjustment information. If you think there has been an error in your score you can request a Targeted Review by 10/15/2018.

CMS had indicated that the public release of MIPS scores on the Physician Compare website should be expected in December of this year. The scores will be viewable on individual Provider Profile pages. It won’t take too long for the comparison websites to make the data available in graphical and searchable formats. Want to compare the MIPS scores of the oncologists in your zip code? No problem. Consumers of healthcare do not care anything about a provider’s Medicare Part B reimbursement. The MIPS score will be all that matters. So far there has been far too little discussion of the effect of a MIPS score on a provider’s professional reputation, but it is coming in just a few months. This will be the unexpected undertow.

There will be two significant impacts of the looming MIPS scores. The most obvious is the effect they will have on Medicare Part B reimbursement. This is what the majority is focused on. These are the incoming and visible waves. The potential impact on professional reputation is poised to be beneath the surface in the unseen undertow. I spoke recently with a national healthcare organization with over 300 MIPS eligible clinicians practicing in geriatrics. The decision was made to report as a group and a MIPS score of 91 was achieved. They expressed confidence that they were in good shape. Well, that will be true if their  competitors have lower group scores but that may not be the case. This will be the first time that providers and healthcare entities that are MIPS eligible will be compared based on a single number. We all love “Top Ten” and “Best Of” ratings. These MIPS scores will be sliced and diced by websites like Healthgrades, RateMDs, and Vitals. The reputational impact of low MIPS scores may deliver a greater blow to the value and bottom line of a practice than any negative adjustment to reimbursement.

There was a great disservice done last year when bad advice was pumped out promoting a MIPS strategy of just avoiding penalties. There is plenty of blame to go around for the national medical associations, consultants, and other entities that gave that counsel. Time to pay attention to those beach signs that warn of dangerous swimming conditions. There should only be one plan going forward. Embrace MACRA/MIPS and pursue a plan that will produce a MIPS score as high as possible. Anything else brings risk and regret. Pay attention to those warning signs on the beach. The lifeguard knows best.