GAO reports on provider performance under MIPS

Oct 01, 2021 - 12:41 PM

At least 93% of clinicians eligible to participate in Medicare’s Merit-based Incentive Payment System earned a small positive adjustment in 2017 through 2019, according to a report released today by the Government Accountability Office. The largest payment adjustment in any year was 1.88%. Median final scores were well above the performance threshold across each of the three years. About 72%-84% of providers earned an exceptional performance bonus, depending on the year.

Some stakeholders interviewed by GAO said bonus points such as those that may be added to the final scores for small practices helped increase scores for certain clinicians who might otherwise be disadvantaged, while others questioned whether the program helps to meaningfully improve quality of care or patient health outcomes. According to CMS, the MIPS Value Pathways — a new way of meeting reporting requirements in 2023 — will help to address some of these challenges by standardizing performance measurement across specific specialties, medical conditions or episodes of care, GAO said.

The Medicare Access and CHIP Reauthorization Act of 2015 created the Quality Payment Program, which providers participate in through MIPS or advanced alternative payment models, and included a provision for GAO to examine the MIPS program. About 950,000 providers (about half of all Medicare Part B providers) were eligible to participate in MIPS in 2019. 
 

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