MIPS first-year results: Strong participation, weak incentives for quality improvement

The vast majority of clinicians participating in the first year of the Merit-based Incentive Payment System (MIPS) avoided a financial penalty. But that seemingly positive result masked a lack of overall improvement in the categories MIPS measures, according to a new study.

Authorized by Congress as part of the Medicare Access and CHIP Reauthorization Act of 2015, MIPS is designed to improve doctors’ performance through increases or reductions—also called payment adjustments—in their Medicare reimbursements. The payment adjustments are based on participants’ scores in the categories of quality, improvement activities, and advancing care information.

The study looks at MIPS scores of about 879,000 clinicians from 2017, the first year in which results affected future Medicare reimbursements. They found that 90 percent attained a composite score of at least 3 out of 100, the threshold for avoiding a reimbursement reduction. The median composite score was 86, and 21 percent scored a perfect 100.

The authors note, however, that participants were required to report in only one of the three MIPS categories, and most chose the category or categories in which they knew they would score well. For example, 34% of those reporting in the quality category scored 100, as did 46% who reported in advancing care information.

Thus, they conclude, “High composite scores were achieved because the vast majority of clinicians who did participate in each category achieved very high scores in those categories,” meaning that overall MIPS performance “was driven by participation in each category, rather than performance across categories.”

Based on their findings, the authors recommend that, among other changes, policymakers modify payment adjustments for clinicians who choose not to participate in all MIPS categories. In addition, given that so many participants performed well in individual categories, CMS should make it more difficult to achieve high scores in order to incentivize consider ways to make attaining high scores more difficult so as to create more incentives for improvement. Without such incentives in the early years of the program, they warn, doctors won’t be prepared for the far more stringent penalties that, under MACRA, will take effect in 2022.

The study, “High Rates of Partial Participation in the First Year of the Merit-based Incentive Payment System,” appears in the September 2020 issue of Health Affairs.