How Does MIPS Impact Oncology

Approximately 38.4 percent of men and women will be diagnosed with cancer at some point in their life, while 7.6 million people die from the disease1. With cancer becoming more common, many patients are starting to seek the highest quality of medical care, which is why it is important for you as a physician to have a high Merit-based Incentive Payment System (MIPS) score. MIPS is a program that evaluates the physician’s quality of care and scores it based on a 100-point system.  It can have a hugereputational and financial impact on an Oncology practice.

CMS considers MIPS to be a budget neutral program with an opportunity to receive incentives, while eligible clinicians who do not comply will receive penalties, -7% in 2019 going up to -9% in 2020. To earn high scores and receive incentives clinicians must score high on Quality, Promoting Interoperability, Improvement Activities, and Cost categories. The weight of each category continues to constantly change every year, with 2019 breakdown

as below:

  • Quality (45%)
  • Promoting Interoperability (25%)
  • Improvement Activities (15%)
  • Cost (15%)

The complexity of MIPS reporting continues to increase since it became effective in 2017, making it imperative for the practices to become well versed with the ever-changing rules and stay ahead of the curve.Along with the complexity, the financial implications have incraeased manifold since inception of MIPS.  In 2018, the maximum incentive was 2% with the maximum penalty at 5%.  In 2019, the incentives have increased but so did the penalty – the new incentive has jumped to a maximum of 7% and the penalty has increased to7%.

Oncology practice revenue is normally quite high, therefore reporting for MIPS or not makes a significant difference to the bottom line. For instance, if an Oncologist were to earn $500,000 Medicare reimbursement annually, then not reporting MIPS would cost them 7% of $500,000 i.e. $35,000.If you were to report for MIPS and score high, instead of paying a penalty your incentive could be up to $28,500 with budget neutrality factor applied.Using MIPS consulting services from a reputed firm likeTriumpHealth not only saves your practice money but also helps boost your reputation and creates opportunities for growth and advancement.

Source: Cancer Statistics. (April 27, 2018). Retrieved from https://www.cancer.gov/about-cancer/understanding/statistics

By: Alexis Cardona, Healthcare Solutions Consultant