MIPS – “I’ll just take the penalty” Part 1

“I’ll just take the penalty”

Unfortunately, I have heard that from more than one practice.  And frankly, when MIPS was first unveiled I was thinking I would do the same.

I am sure the good folks at CMS that wrote MIPS had great intentions.  They likely wanted to ensure the rules incentivized providers to do all the good things they could imagine that would result in better patient care and lower costs for Medicare.

That said, the more I have learned about MIPS the easier it looks. CMS has also replaced their early very complicated explanations with much better tools such as this one – https://qpp.cms.gov

With more understanding I have also come to the following realizations:

  1. It is not all or nothing. Doing just a little can keep you from incurring the penalty.  Maybe it’s cooler to say “I’ll just take the penalty” but if it’s not really that hard to avoid getting penalized is that really a smart move?
  2. This is not going away. It may make you angry, you may want to rebel but at the end of the day, a bipartisan congress and president signed a law that charged CMS with reducing Medicare costs by implementing penalties and incentives.
    • It took congress 15 years to fix the prior SGR model which was slated to decrease Medicare reimbursement by double-digits so it is unlikely Congress is going to change MACRA anytime soon.
  3. It’s going to get worse. That 4% penalty in 2019 based on 2017 is going to become 5% in 2020 and keep increasing to a planned 9% by 2022.
  4. There is also an incentive – so the real cost of not doing MIPS is double the penalty.
    • If a provider receives an average of $200,000 a year from Medicare the first year penalty is $8,000 but you’re also giving up a potential $8,000 incentive for a total potential loss of $16,000.
  1. Not doing MIPS is literally going to make you look like a bad provider. CMS has already launched physician compare – https://www.medicare.gov/physiciancompare/, and this site includes a quality score for each provider.  Not doing anything at all for MIPS will get you a 0/100.
    • According to a 2013 study by Software Advice, 62% of Americans turn to online reviews when choosing a doctor.
    • But people on Medicare don’t use the Internet! Actually, according to Statistica, in 2016, 84% of Americans aged 64 and older used the Internet and that percentage is steadily increasing.  In addition, the caregivers for older adults are typically younger and even more likely to be online.
  1. EHRs are not the enemy. Similar to “just saying no” to MIPS, rejecting the concept of using an EHR has become the cool thing to do in some circles.  However, EHRs existed and many had strong growth rates well before meaningful use and MIPS – because they helped providers and their patients.
    • Unfortunately, many EHRs cropped up to take advantage of the “meaningful use revolution” and focused on CMS’s rules, not providers. Others that were more provider focused lost that focus.  It is a tough balancing act for an EHR vendor but there is a way to make it easier for providers, support improved patient care AND facilitate MIPS participation.

So, what’s a provider to do?  We’ll offer some suggestions in next week’s blog.