The Many Problems With Medicare ’s MIPS Exclusion Thresholds

The 2015 Medicare Access and CHIP Reauthorization Act (MACRA) allows the secretary of the Department of Health and Human Services, Tom Price, to define a low-volume threshold for the purpose of excluding some number of eligible clinicians from participating in MACRA’s Merit-Based Incentive Payment System (MIPS). Secretary Price may identify a minimum number of beneficiaries, a minimum number of items and services, and a minimum amount of Part B charges that if not exceeded would, again, exempt a provider from MIPS participation. This year, MIPS performance year one, those eligible clinicians with less than or equal to $30,000 in Part B allowable charges, or less than or equal to 100 Part B beneficiaries served, are excluded. Under the 2018 proposed MACRA rule released this past June 20, Secretary Price or the Centers for Medicare and Medicaid Services (CMS) is, for performance year 2018, tripling the exclusion dollar amount to $90,000 and doubling the number of beneficiaries served to 200. This past May, CMS informed more than 807,000 clinicians, or approximately two-thirds of Medicare Part B clinicians, that they would be exempt from MIPS this year. The proposed 2018 rule would again exempt two-thirds of clinicians, or more than 900,000. This percentage and number would be substantially higher, however. CMS estimates clinicians participating under the MACRA alternative payment model (APM) pathway would double between 2017 and 2018, or from an estimated 70,000–120,000...
Source: Health Affairs Blog - Category: Health Management Authors: Tags: Costs and Spending Featured Insurance and Coverage Medicare Payment Policy Quality MACRA Medicare Access and CHIP Reauthorization Act Merit-Based Incentive Payment System tom price Source Type: blogs