Recently CMS Acting Director Andy Slavitt published a blog entry that gives a peek into CMS intent to provide flexibility for providers concerned over the aggressive timetable for MIPS Rollout in 2017. Although details will not be forthcoming until the Final Rule is published in November, all the articles, blogs and tweets have expressed appreciation for the ability to defer participation in MIPS. That "deferral" could take the form of either partial year participation for a reduced payment adjustment, or a partial data submission designed to avoid penalties.
Here is the unintended consequence, and potential windfall ...
Start with the reminder that MIPS is a competition. Those providers with low scores relative to the national average pay a penalty. That penalty is used to fund positive Medicare adjustments to those providers with high relative scores. Now consider Director Slavitt's two flexibility options:
Option 1: As long as you submit some data to the Quality Payment Program, including data from after January 1, 2017, you will avoid a negative payment adjustment.
Option 2: You may choose to submit Quality Payment Program information for a reduced number of days. This means your first performance period could begin later than January 1, 2017 and your practice could still qualify for a small positive payment adjustment.
If you are wondering about more details, then you need to wait until the Final Rule is published in November.
Now let's think about what might happen under Director Slavitt's flexibility options if a large number of low scoring providers take themselves out of the pool with one of these options. As a result, the remaining pool of full MIPS participants only contain high scoring providers. Based on the way MIPS scores and payments are calculated, the lowest tier of these high scoring providers will pay the penalties to fund their highest scoring colleagues. Interesting, yes?
More interesting is the next wave of logic. As provider management teams anticipate the above scenario, even those providers with the potential to score well could elect to take the "no penalty" option and wait for a later year in which the playing field is again level with a broad population of competitors. The net effect could well be a de-facto deferral of MIPS / MACRA for 2017 for all but the very best competitors.
Here is the takeaway: You can either take one of the above "safe" routes and minimize your data submission efforts or if you decide to play, make sure your scores are well optimized for MIPS. The toughest and most successful competitors will develop breakout strategies that involve detailed analysis of their options, and detailed configuration of their submissions. These analyses, and submission strategies will stretch the capabilities of spreadsheets and manual techniques. The best way to succeed will be the employment of software designed just for the purpose of MIPS Optimization.
But ... and here is the home run ... for those who optimize and score well, remember the Bonus Pool that CMS has set aside is $500,000,000 to be spread across the top tier performers. And if the size of the overall pool is diminished by Director Slavitt's flexibility options, that pool is spread across a smaller number of participants. So soon, you need to decide your MIPS Strategy.
Will you choose to "sit out a round", or "seize the day"?