Medicare Quality Payment Program
The year 2017 was the first of the Quality Payment Program, implementing Congressionally mandated new value-based payment system under Medicare for physicians. This includes the Merit-Based Incentive Payment System (MIPS), the fee-for-service pathway through which most ophthalmologists participate.
Thanks to the Academy’s IRIS® Registry (Intelligent Research In Sight), which provided seamless reporting for the MIPS program, 100% of ophthalmologists that participated in 2018 qualified for a bonus on all their 2020 payments and 81.86% qualified for an exceptional performance bonus. A similar result was recently announced for 2021 bonuses.
For the upcoming fifth year of MIPS, the Academy urged the agency to address the issues presented by the COVID-19 public health emergency. Specifically, we encouraged CMS to implement its automatic extreme and uncontrollable circumstances policy for the 2020 performance year.
We continue to encourage CMS to reevaluate its low-volume threshold – where practitioners who do not see a minimum number of Medicare patients are exempt from the program. The low-volume threshold currently exempts more than 60 percent of all Medicare practitioners, keeping the money available for individual performance bonuses under two percent. The Academy has also recommended giving physicians more credit for participation in clinical data registries like the Academy’s IRIS® Registry. We have also encouraged CMS to reinstate the small-practice bonus to the MIPS final score.
As the MIPS program ramps up, the threshold to avoid a penalty is slowly increasing as required by statute. The Academy worked to make it as easy as possible for all ophthalmologists to avoid penalties in 2022 for 2020 performance. Visit http://www.aao.org/medicare/avoid-a-penalty for more information.