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  • MIPS Manual 2017—Financial Impact: The Additional Payment Adjustment Factor (Tap Into a $500M Bonus Pool)

    By Rebecca Hancock, Flora Lum, MD, Chris McDonagh, Cherie McNett, Jessica Peterson, MD, MPH, and Sue Vicchrilli, COT, OCS
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    This content was excerpted from EyeNet’s MIPS Manual 2017.

    The 70-point additional performance threshold sets the bar for exceptional performance. If your 2017 final score is 70 points or higher, an additional payment adjustment factor will be applied to your 2019 Medicare payments. If you don’t have an EHR system, scoring 70 points will be an extreme challenge.

    Not budget neutral. These additional bonuses are funded by an additional $500 million per year that is being provided during the first 6 payment years of the program. The money will be paid out during payment years 2019-2024, based on final scores during performance years 2017-2022.

    This extra bonus will be based on a linear sliding scale. CMS won’t define that sliding scale until after the performance year is over. The regulations state that the scale is likely to be +0.5% at the lower end (if your final score is 70 points) and it can’t exceed +10% at the higher end (if your final score is 100 points). CMS may reduce that +10% upper limit using a scaling factor. Table 17B shows a hypothetical sliding scale (orange dotted line) for the additional payment adjustment factor.

    Example. In 2018, after CMS has calculated the final scores for all MIPS participants, it calculates the scaling factor that would be needed to distribute the $500 million-bonus pool among those who scored at least 70 points. If it determines that the scaling factor is 0.0625, this means that the maximum additional payment adjustment factor is reduced from +10% to +0.625% (10.0 × 0.0625). This would be applied to you if you have a 2017 final score of 100 points.

    Table 17B
    Table 17B. Exceptional performance bonus: Meet or exceed the 70-point additional performance threshold, and you will receive an additional payment adjustment factor based on a linear sliding scale (orange dotted line).
    Table 17C
    Table 17C. Bonuses are cumulative. If you score at least 70 points, the sum of both bonuses (black line) will be applied to your 2019 Medicare payments. * Please note: These sliding scales are merely illustrative. CMS won’t define these 2 sliding scales until 2018, after it has assigned 2017 final scores to all of this year’s MIPS participants.

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    Next: Financial Impact: How the Bonuses and Penalties Will Be Applied

    Note: Meeting regulatory requirements is a complicated process involving continually changing rules and the application of judgment to factual situations. The Academy does not guarantee or warrant that regulators and public or private payers will agree with the Academy’s information or recommendations. The Academy shall not be liable to you or any other party to any extent whatsoever for errors in, or omissions from, any such information provided by the Academy, its employees, agents, or representatives.

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