Specialists could see 16% variability in payments under MIPS in 2018

Emily Rappleye (Twitter) - Print  | 

Physician specialist Medicare Part B payment adjustments could fluctuate by up to 16 percent positively or negatively under the 2018 proposed rule for the Medicare Access and CHIP Reauthorization Act, according to an analysis from Avalere, a Washington, D.C.-based consulting firm. 

If the proposed rule is approved, these payment fluctuations would occur in MACRA's Merit-based Incentive Payment System beginning in the 2018 performance year. Changes in the proposed rule would add Medicare payments for Part B drugs into the calculation for the MIPS payment adjustment, which would disproportionately affect physician specialists, according to the report. 

"Certain specialists administer more Part B drugs than others and, therefore, may be exposed to significant financial risk and payment swings year-over-year under the CMS proposal," John Feore, director at Avalere, said in a statement. "If the proposal is finalized, these specialists could see substantially higher payment penalties or rewards than their counterparts who administer fewer Part B drugs."

Specialists such as rheumatologists, oncologists and ophthalmologists are particularly subject to greater risk due to this provision, according to Avalere.  

Additionally, many specialists do not qualify for participation in any Advanced Alternative Payment Models, so they will be unable to avoid the risk associated with adding drugs to the MIPS calculation. 

 

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