CMS, MACRA – MIPS, and Drawing the Short Straw

by | Oct 17, 2019 | MIPS

Now, I’m not a mathematician, but I can count to ten. So, I wasn’t expecting any problems when I decided to look at the recently released MIPS Final Scores for the 2017 reporting period. It is a bit hard to find the Final Scores as they are not viewable on the Profile Pages at the Physician Compare website hosted at Those numbers, while available, require a journey into the depths of large data bases. Sure, would be nice if they were easier for John Q. Public to find. The 2017 MIPS final scores (affecting 2019 Medicare reimbursement) are in two different data bases depending on whether the reporting was done via the Individual or Group method.

Not too long-ago CMS released a report entitled the “2017 Quality Payment Program Reporting Experience”. Stated in that report is: “….out of the 1,057,824 clinicians eligible for MIPS for the first performance year, 93 percent received a positive payment adjustment or better, whereas other two percent earned a neutral payment adjustment. Only five percent of MIPS eligible clinicians (EC)  received a negative payment adjustment for their 2017 performance….”. At first glance that looks pretty good but is it? Well, it depends, and here is where the math falls apart.

While there is truth to the CMS claim that 95% of 1,057,824 ECs achieved a 2017 MIPS final score of 3 or higher, this is also true:

  • The 2017 Group Reporting MIPS data base listed 22,599 groups of which 8,005 (35.4%) scored zero.
  • The 2017 Individual Reporting MIPS data base listed 413,233 individuals of which 31,591 (7.6%) scored zero.

For the 2017 MIPS reporting year all that was required to avoid a reimbursement penalty was to score 3 out of 100 possible points. This only required perhaps 5 minutes of work during the entire year. All you had to do was to report one quality measure on one patient, no EHR required, and you avoided a penalty. CMS tells us that only 5% of MIPS eligible clinicians failed to meet that minimum score of 3. But that is not the whole story. Based on a deeper review of the data it is obvious that there are winners and losers. It is easy to see who the losers are, those ECs who reported as a Group and probably had a relatively small number of providers in their group. I continue to be concerned about the ability of the MACRA – MIPS program to maintain a level playing field for individuals vs. small groups vs. large groups. Let’s hope additional education and support is being offered to those that have drawn the short straw.


If you or someone in your organization needs to get up to speed on the details of the MACRA – MIPS program here is a great way to expand your knowledge. And don’t forget to apply Coupon Code EMRADVOCATE20 at checkout to receive a 20% Discount.

Register now for November Live Workshop: Become a 2019/2020 Certified MACRA-MIPS Program Professional (CMPP) 


EVENT PRESENTED LIVE November 6, 7, 13, 14, 2019 (1 hour per day) Noon ET, 11 a.m.CT, 10 a.m. MT, and 9 a.m. PT

COURSE DESCRIPTION: It is that time of year again – MACRA-MIPS is changing for 2020! If you are the MIPS expert in your organization, or if you teach/consult/attest for others, it is important to make sure you are up on the latest regulatory requirements. In this 4 hour certification course, we will review the changes to overall scoring, look at the individual categories and how each has been modified in the NEWEST final rule from CMS, and discuss planning so that you can achieve exceptional performer status!