Specialists risk wide swing in payments under MIPS proposal, Avalere says
- Medicare payments to some specialists could rise or fall by as much as 16% for the 2018 performance year, if CMS finalizes plans to change how it calculates Merit-based Incentive Payment System (MIPS) adjustments, a new Avalere analysis concludes.
- Rheumatologists, oncologists and ophthalmologists are among specialists that bill for more Part B drugs and could see large payment swings.
- Under the proposed rule, Part B drug payments would now be factored into a physician’s total billed Medicare allowed charges when determining MIPS payments. That’s a change from pre-MIPS programs like Meaningful Use and the Physician Quality Reporting System, which only consider Medicare physician fee schedule services, the authors say.
“Certain specialists administer more Part B drugs than others and, therefore, may be exposed to significant financial risk and payment swings year-over-year under the CMS proposal,” John Feore, director at Avalere, and co-author of the study, said in a statement. “If the proposal is finalized, these specialists could see substantially higher payment penalties or rewards than their counterparts who administer fewer part B drugs.”
In fact, the extent of risk would increase as MIPS reaches full implementation, reaching +/-29% in performance year 2020, the authors note.
For the second year of the program, CMS is increasing the low-volume threshold to $90,000 or less in Medicare Part B charges or 200 or fewer Medicare patients a year. The initial threshold was $30,000 in Part B billings and 100 Medicare patients. Just 36% of clinicians will qualify for MIPs after all exemptions, but they comprise 58% of Part B charges.
This first year will give clinicians their first inkling of how they’ll fare under MIPS and a chance to consider the Part B drug ramifications without them actually having an effect.