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CMS offers flexible reporting options: What option should your practice choose?

In response to complaints that the planned January 1, 2017, launch date for the new Medicare Merit-Based Incentive Payment Program (MIPS) is too much too fast, CMS Acting Administrator Andy Slavitt announced the “Pick Your Pace” opportunity in a September 8 blog post.

According to Slavitt, MIPS-eligible clinicians – including nearly all physicians and non-physician practitioners participating in Medicare Part B – will have four options in 2017:  

    Option 1: Report “some” data to avoid the MIPS penalty
    In what appears to be a variation on the current Physician Quality Reporting System (PQRS), a MIPS-eligible clinician can avoid any MIPS penalty on 2019 Medicare Physician Fee Schedule payments by submitting “some” data.  By selecting this option, a clinician forgoes the opportunity to earn any bonus payment.

    Slavitt offers no insight on what “some” data may include. Nor does he explain whether CMS will calculate and publish a MIPS composite performance score for clinicians who select this option. These details will not be revealed until CMS publishes the MIPS final rule prior to November 1, 2016 (and we will not venture to guess whether it will be a “trick” or a “treat”).

    Option 2: Shorten the initial performance period to less than a full year
    Alternatively, a MIPS-eligible clinician can elect to start the initial performance period on some day after January 1, 2017. At this point, we do not know how late in the year a clinician will be able to push this date; again, this will be addressed in the final rule. Clinicians who elect this option will be eligible for MIPS bonus payments, but also may face penalties.

    Option 3: Proceed with business as usual
    Clinicians who are ready to go on January 1, 2017, may proceed as planned, submitting data for the entire year.  CMS anticipates those clinicians who have previously reported PQRS and attested to meaningful use will select this option.

    Option 4: Participate in an Advanced Alternative Payment Model
    As explained in detail in the proposed rule, a clinician who participates in one of a specified list of Advanced Alternative Payment Models (e.g., Medicare Shared Savings Track 2 or 3) and who receives a sufficient percentage of his or her Medicare payments or sees a sufficient percentage of his or her Medicare patients through that model would not be subject to the MIPS adjustments. Instead, the clinician would qualify for a 5 percent incentive payment in 2019.

Although not identified in Slavitt’s blog post, there is also an Option 5: a clinician may elect not to report any data for 2017. Clinicians selecting this option will be subject to the maximum 4 percent penalty in 2019 and will be assigned a low MIPS composite performance score.  (The score will be more than zero, as some components are calculated by CMS using claims data.) That score will be reported publicly on the Physician Compare website.

What should you choose to do? – Familiarize yourself with MIPS

Until the details surrounding Options 1 and 2 are presented in the final rule, a clinician cannot make an informed decision regarding the best alternative in his or her circumstances. The one option a clinician should eliminate now, however, is Option 5, given the negative reputational impact of a low composite performance score as well as the financial penalty. 

To that end, clinicians should be familiarizing themselves with the MIPS program, especially the quality reporting requirements. Just as a practice must have the capability to submit claims electronically to payers, a practice also must develop the capability to compile and submit quality data in order to receive full payment. Slavitt’s announcement of a temporary, partial easing of the MIPS requirements only confirms this fact.

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