Merit-based Incentive Payment System (MIPS)

GPA Capital’s job is to assure that we can not only “source” your desired funding request, but sustain and retire the debt. You must preserve and increase your gross revenue so that your Cash Available for Debt Service (CADS) is sustained and growing. MIPS speaks directly to that endeavor:

The Merit-based Incentive Payment System (MIPS) is the most massive modification in a generation to Medicare Part B reimbursement. As part of the shift from “pay for performance” to “pay for value” the program is designed to be a zero-sum process. On an annual basis affected clinicians will receive a Composite Score, based on submitted data, that ranges from 0 – 100. High scoring clinicians will receive increased Part B reimbursements that will be taken from those with low scores. The MIPS program is much more complex than the Meaningful Use program and the stakes are much higher.

Your Cash Flow Determines Funds Available

Loan Amount PMT CADS* MIPS +/- DSCR
$1,650,000 $10,000 $13,000 0% 1.3
$1,500,000 $9,000 $11,830 -9% 1.3
$1,800,000 $10,900 $14,170 +9% 1.3

*Cash Available for Debt Service

Why the MIPS Composite Score matters:

  1. Part B Payment Adjustments: 2017 is the first MIPS performance year and will affect 2019 Part B reimbursement. The payment adjustment begins at a range of 4% +/- (8% swing) and by 2022 a 9% +/- range (18% swing). Additional bonuses are available for “exceptional performers”.
  2. Practice Valuation: There is a direct correlation between practice value and income. A practice with a high group MIPS score is worth more than one with a low scoredue to higher income.
  3. Potential Provider Compensation: As the MIPS score is attached to a clinician’s NPI number it is portable and moves with a clinician. If a practice or hospital hiresa clinician with a low MIPS score they will have less Part B reimbursement value than if they had a high score.
  4. Professional Reputation: The MIPS scores will be public and posted by CMS on the internet. A high score will attract patients.
  5. Impact on Loan Availability and Maintenance: A low MIPS score will decrease cash available for debt service (CADS) and adversely affect the debt service coverage ratio (DSCR).

Solution: A strategy leading to higher MIPS score requires a detailed analysis of data as well as expert knowledge of submission methods, group vs. individual reporting, and the selection of appropriate Clinical Quality Measures.

GPA Capital’s partner company EMR Advocate, Inc. is the acknowledged experts in the MIPS program. Utilizing MyMipsScore, the most robust MIPS data analytic tool, they bring the ability to identify current MIPS score status and deliver actionable guidance to boost those scores. GPA Capital/ EMR Advocate, Inc. offers the MIPS Roadmap 2017 as a tactical engagement to implement a fully functional instance of MyMipsScore and utilize real data for determining the current MIPS status of the organization and devising a strategy for maximizing it.

The MIPS Roadmap starts with a preliminary meeting to define the scope and data requirements. During this meeting, the team at GPA Capital/ EMR Advocate, Inc. works with the client to collect a snapshot of the client's relevant EHR data. The Roadmap session begins with an overview of MIPS to ensure that all participants have a basic understanding of MIPS. The conversation quickly turns to analyzing the organization's data. The analysis includes but is not limited to:

The final segment of the Roadmap Session is spent on developing a strategy for maximizing the MIPS score using MyMipsScore's patent pending MIPS Score Simulator™. While most of this session is spent on analyzing quality measures, it is not uncommon to include ACI analysis for large groups. The goal is to identify multiple scenarios for the organization to achieve a MIPS score of 100.

Importance of Getting Started

For a conference, click to schedule.

Caution, there are innumerable websites offering to assure you no penalty for 2019. It does nothing to improve your cash flow and you will wind up with a 3 out of 100 Reputation Score. This will effect your patient population and cause negative growth in your cash flow. Note: 38% of providers are affected which, although a large number, these same providers account for 58% of Medicare Part B billing, which is huge.