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Is Your Physician Practice Leaving Money on the Table? Thinking About MIPS

October 23rd, 2023
October 23rd, 2023

By Karen Sorensen, HealthStream Associate Vice President, National Initiatives 

CMS reports that only 69% of the nearly 1.36 million physicians and clinicians eligible to participate in the Physician Quality Reporting System (PQRS) did so in 2015, the most recent year for which data is available. PQRS is the forerunner to the new Merit-based Incentive Payment System (MIPS) which goes into effect this year. If those statistics hold, that means that potentially more than 30% of eligible clinicians could receive a 4% downward adjustment to their Medicare payments in 2019 – simply because they fail to report quality measures in 2017. And it only gets worse. By 2022, 9% of clinicians’ Medicare payments will be at risk.

But there is a bit of relief. During this transition year, CMS is allowing clinicians some leeway in terms of reporting. If a clinician or practice submits just one quality measure or just one improvement activity, it can avoid the 4% downward payment adjustment. The good news is that you may already be doing some of these things.

In the table below, we have listed a few of the MIPS measures and the HealthStream solutions that will allow you to satisfy the reporting condition. For example, if your practice is conducting CG-CAHPS or CG-Express, you could receive credit for multiple measures under the Clinical Practice Improvement Activities category. Although CMS is allowing practices to pick their pace of participation, the more measures a practice submits the greater the likelihood of earning a positive payment adjustment. 

In the proposed rule for year two of the Quality Payment Program, CMS promises to continue to work to streamline the program and reduce clinician burden. For example, the CAHPS for MIPS Survey will continue to be voluntary, and CMS is proposing to significantly shorten the survey.    

The stakes are high. Whether you are going for full participation or just seeking to avoid the negative payment adjustment, HealthStream can help. If you haven’t done so already, we encourage you to talk with your HealthStream team to learn how we can help you satisfy MIPS reporting requirements. You don’t have to leave money on the table!

June 30th MIPS Registration Deadline

If your practice is considering conducting the CAHPS for MIPS Survey in 2017, you must register with CMS by June 30th. Even you aren’t completely sure you want to conduct the CAHPS for MIPS Survey, it’s important to register before the deadline. You can always change your mind. Practices must also register by June 30th if they plan to participate in MIPS via the CMS Web Interface. 

Additional Resources

  1. 2017 Registration Guide for the CMS Web Interface and CAHPS for MIPS Survey
  2. https://qpp.cms.gov/
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