Facilitate Ophthalmologists’ Success in MIPS
What We Told You in February
Our profession is among the most successful in federal quality-payment programs. The Academy is committed to ensuring you remain at the top. That means more credit for participation in the Academy’s IRIS® Registry, fairly graded, ophthalmology-developed quality measures and halting any expansion in 2020 of the Merit-Based Incentive Payment System’s cost category.
What’s Happening Today
Sidney Gicheru, MD, of Dallas, listens intently during a Mid-Year Forum 2019 session on the Academy’s IRIS Registry. Ophthalmology’s registry is a proven asset for helping our profession achieve MIPS success.
It’s been an active year so far, with congressional leaders reiterating their support for MIPS. But federal lawmakers acknowledge that there is room for improvement. We’re at the forefront of efforts to ensure MIPS remains relevant and fair to specialists, an expectation that Congress established when it voted to replace the sustainable growth rate formula with a value-based payment program. The Academy believes that the IRIS Registry is a big part of the solution.
Helping MIPS Evolve
The Academy worked to ensure our profession was prepared for the Merit-Based Incentive Payment System and avoided penalties. But MIPS could still be improved with lessons gleaned from two reporting years. The fixes needed are apparent. Rather than call for the program’s repeal, the Academy is requesting refinements – adjustments that can help Medicare quality-performance reporting become more clinically relevant and less frustrating and give ophthalmologists the best chance for success.
That’s why we’re part of a medicine-wide effort to spur new congressional fixes to the law that resulted in the Merit-Based Incentive Payment System.
We told the Senate Committee on Finance in May to use its Medicare oversight powers to strengthen the IRIS Registry’s role in MIPS. The Academy testified that Medicare benefits from incentivizing qualified clinical data registries in the areas of quality and value improvements. Registries are proven to provide practitioners with real-time feedback and real-world evidence and can help demonstrate the effectiveness and outcomes for commonly performed procedures.
Together with the American Medical Association and 119 other health care stakeholder organizations, we’re urging Congress to make adjustments to the law that created MIPS, starting with halting a planned six-year physician payment freeze that begins in 2020.
Although Medicare intends to pay its other providers with regular, stable fee updates, physicians, because of the Medicare Access and CHIP Reauthorization Act, are subject to a significant pay freeze. We want Congress to identify a stable and sustainable revenue source that will allow CMS to give physicians annual pay increases that help us sustain our practices.
If you’re seeking evidence that the Academy’s investment in the IRIS Registry was sound, we got it this month. Not a single ophthalmologist who reported MIPS in 2018 using the IRIS Registry will be hit with a penalty in 2020 – which is 5% of practitioners’ Medicare revenue – according to preliminary results from CMS. The average score for the 10,000-plus ophthalmologists using the IRIS Registry exceeded MIPS’ superior performance threshold. It makes them eligible for exceptional performance bonuses, which CMS funds via a separate bonus pool.
According to the data, individuals and groups of ophthalmologists who submitted data to the IRIS Registry for MIPS in 2018 had an average score of 83 out of 100 points. The threshold to avoid a penalty for that reporting year was 15 points. Not only that, but 82% also met the exceptional performance threshold of 70 points. Because this data is preliminary, it doesn’t include cost category points, which are established by CMS based on Medicare claims. This means scores could be even higher.
Ophthalmologists who integrated their electronic health records with the IRIS Registry did even better. These reporters achieved the program’s highest scores among ophthalmologists; 96% achieved a score that makes them eligible for an exceptional performance bonus.