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Published On: November 21, 2017 by CCS

How MIPS is Helping Physicians Manage Medicare Payments and Transform the Patient Care Experience

MIPS Medicare

For a long time, US clinicians received Medicare payments based on a fee-for-service (FFS) model. However, this system was problematic for two reasons. First, it meant that physicians were forced to focus on the quantity of patients they could see instead of providing the highest quality of care. Second, it resulted in huge cuts to clinician Medicare payments across the board.

Despite annual attempts to fix the model, it was recently scrapped and replaced with the Quality Payment Program. This new model makes it easier for physicians to focus on giving quality care without having to worry about rushing through patient visits to ensure quantity quotas are reached.

Breaking Down the Model: What is the Quality Payment Program?

The Quality Payment Program reforms Medicare Part B payments for more than 600,000 clinicians across the country. The new model also helps to improve patient care across the entire healthcare delivery system, by putting the focus back on quality care instead of quantity of visits.

The Quality Payment Program offers clinicians two options:

MIPS – The Merit-Based Incentive Payment System

MIPS offers clinicians the possibility of Medicare payment adjustments based on the quality of care, practice improvement, advance care information, and resource use and cost.

Advanced APMs – Advanced Alternative Payment Models

Advanced APMs offer clinicians the possibility of Medicare payment adjustments based on the use of innovative Electronic Health Record (EHR) software.

What Are the Benefits of the Quality Payment Program for Physicians and Patients?

The Quality Payment Program (QPP) is defined by its ability to help physicians provide a better care experience so patients are getting the quality of care that they deserve. The reform of the FFS model and the implementation of the Quality Payment Program offers huge benefits for both clinicians and patients – let’s explore some of the key benefits below.


  • Streamlined reporting
  • Standardized, evidence-based performance measures
  • Elimination of redundancies, which allows clinicians to focus on patient care
  • Promotes industry alignment through multi-payer models
  • Incentivizes care that focuses on improved quality outcomes


  • Increased access to higher quality healthcare services
  • Enhanced coordination of care through a patient-centered approach
  • Improved health outcomes and results

Quality vs. Quantity: How Does MIPS Help Physicians Do Better and Optimize Medicare Payments?

For physicians who aren’t yet ready to adopt the Advanced APMs option, MIPS is the perfect starting point in Medicare payment model optimization. First and foremost, MIPS moves Medicare Part B clinicians to a performance-based payment system instead of the traditional per-visit payment model. Second, MIPS provides clinicians with the flexibility to choose the activities and quality performance measures that are most significant to their practice.

There are four MIPS Performance Categories and each is weighted on a 100-point scale:

  1. Quality (60%)
  2. Cost (0%)
  3. Improvement Activities (15%)
  4. Advancing Care Information (25%)

Note that these are default weights and that weight allotments can be adjusted in certain circumstances. Clinicians should aim to score as close to 100 as possible.

Because 2017 is the transition year from FFS to QPP, clinicians can choose the pace at which they’d like to participate in the new model: Test Pace, Partial-Year or Full-Year. To participate in the Full-Year category, clinicians were required to start submitting regular performance data as of January 1st, 2017.

To participate in the Test Pace category, clinicians must submit some amount of data after January 1st and before December 31st, 2017. For the Partial-Year category, clinicians are required to submit data covering a 90-day period, sometime after January 1st and before December 31st, 2017.

Each category, depending on data submitted, offers clinicians the ability to receive neutral or positive Medicare payment adjustments. However, those who do not participate in MIPS during this transitional year face a negative Medicare payment of up to 5%.

Does Your Practice Qualify? What Kind of Clinicians Are Eligible for MIPS Participation?

Clinicians eligible for MIPS participation must be Medicare Part B clinicians who are billing more than $30,000 per year and seeing more than 100 Medicare patients per year.

A variety of clinicians qualify under these conditions including:  

  • Physicians
  • Physician Assistants
  • Nurse Practitioners
  • Clinical Nurse Specialists
  • Certified Registered Nurse Anesthetists

It’s also important to note that clinicians who have just enrolled in Medicare for the first time are not eligible for MIPS participation until the following performance year.

Don’t Miss Out: A Last-Minute Checklist for 2017 MIPS Participation

As noted, to participate in the transitional 2017 year and avoid a 5% penalty, clinicians MUST submit their 90-day period data by December 31st, 2017. That leaves less than a month for last-minute submissions. If you’re wondering what’s required, consult this quick checklist to make sure you submit all the data required:

  • Determine your eligibility status
  • Choose if you will be reporting as an individual or a group
  • Determine the Performance Categories most relevant to your practice
  • Collect and organize necessary performance data
  • Choose a data-submission option – Test Pace or Partial Year
  • Submit required data BEFORE December 31st, 2017 to avoid a negative Medicare adjustment

This is a condensed checklist to help with last-minute MIPS preparation, but there are countless resources online to help clinicians make the most out of MIPS participation. For full details, check out some FAQ’s here:

No matter what kind of care you provide, a Medicare payment model designed specifically to better support clinicians AND patients is a no-brainer. MIPS and the entire Quality Payment Program is based on a cycle of high-quality, patient-focused care, useful feedback from physicians and continuous improvement of the healthcare experience.

For physicians looking to better streamline processes, deliver better care and improve outcomes for all involved, participating in MIPS is a must. By focusing on enhancing the patient and clinician experience to improve overall care and service delivery, MIPS is an amazing and strategic tool that helps physicians refocus on quality care instead of quantity of visits.

If your practice wants to participate in MIPS for the 2017 transitional year, the deadline is fast approaching. December 31st, is the last day to submit performance data without facing a negative 5% Medicare payment adjustment.

If MIPS has your head spinning, don’t be afraid to reach out to local experts for guidance or consult other clinicians who may already be participating. A payment model that seeks to benefit both patients and physicians could hold huge benefits for the transformation of our healthcare system – make sure your practice doesn’t miss the boat!


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