As the first Quality Payment Program performance data from 2017 has become available to the public in 2019, MIPS scoring and its impact on practices is beginning to get very real.


A survey conducted in 2018 by University of Pennsylvania scholars, and published in the July issue of Health Affairs, revealed low levels of familiarity with the Merit-based Incentive Payment System (MIPS). The research found that 60 percent of physicians reported being not at all or only slightly familiar with MACRA and its requirements, and only 8 percent reported being very familiar.

Here are the top 5 reasons that healthcare providers should be paying close attention to their score:

1 – Affects your bottom line

CMS designed MIPS with the anticipation of creating winners and losers.

MIPS providers who score well will receive annual bonuses of 4 percent in 2019, 5 percent in 2020, 7 percent in 2021, and 9 percent for 2022 and beyond. On the flip side, physicians who don’t meet all requirements will face penalties of those same amounts for those years.

2 – Large groups are seeing this as an opportunity to gain an edge

The MIPS payment adjustments are a zero-sum game. All the negative payment adjustments will be equal to the positive payment adjustments.

Nobody understands this better than large, corporate practices who see this as an opportunity to gain a further edge on independent practices. Many experts predict this will widen the gap between corporate medicine and independent practices as larger groups have more resources to maximize their score.

3 – Scores to be published

In an effort to aid patients in selecting the right healthcare providers, CMS will be publishing physicians’ reporting grades on their Physician Compare website as well as sharing the data with third party rating sites such as Yelp and HealthGrades.

It’s unclear how private insurance providers will use this information, but it’s easy to imagine that repercussions could go far beyond CMS.

4 – Can affect job mobility

MIPS scores are tied to each healthcare provider’s NPI, which could affect job mobility for better or worse. If a provider has a low score, potential employers assume your low score and the corresponding payment adjustments. This could potentially help or hurt a healthcare provider’s ability to get the position they want or negotiate their desired salary.

5 – Opportunity to earn bonuses

CMS has also outlined ways for doctors to score higher and become eligible for positive payment adjustments. Your practice may be eligible for “special scoring” (including certain exceptions and bonuses) that increase your score if you are part of a small practice or meet certain other criteria. For those who seek to achieve a higher score, there are several other metrics to keep in mind to increase your score. Those “exceptional performers” who score more than 70 points will be eligible for an additional positive MIPS payment adjustment and may share in the pool of $500,000,000 of funding available for the year


If you are a healthcare provider who is looking for opportunities to add services to your practice designed to help you achieve a higher MIPS score, contact your Every Ancillary Practice Consultant. They will supply you with a COMPLIMENTARY Comprehensive Ancillary Catalog, which details over 50 bolt-on ancillary verticals that can help you achieve higher scoring.