Some 2018 MIPS bonuses may not be worth the investment

A bonus of up to 10 percent has been proposed for using an upgraded electronic health record (EHR) system for reporting in the Merit-based Incentive Payment System (MIPS) in 2018, but speakers at two recent industry conventions warned it’s likely not a worthwhile investment for providers.

As part of the proposed MIPS rule, clinicians could use either 2014 or 2015 certified EHR technology (CEHRT) for the Advancing Care Information (ACI) category of MIPS. The 10 percent bonus offered an incentive for providers to still make the change, along with a 90-day ACI reporting period, which gives provider until October to have a 2015 CEHRT in place.

If a provider is scheduled for an upgrade to the 2015 edition, it could be an advantage, according to Michael Marron-Stearns, MD, CEO of health IT consulting firm Apollo HIT.

“If you’re doing it for return on investment reasons, it may not be enough to pursue it, but it is great preparation for 2019, when we think the 2015 edition will be required,” Stearns said at the American Health Information Management Association (AHIMA) conference in Los Angeles.

The incentive to upgrade in 2018 is “minimal,” in the opinion of Robert Tennant, director of health IT policy for the Medical Group Management Association. Speaking to HealthExec at the MGMA conference in Anaheim, California, he said transitioning to 2015 CEHRT next year would likely too be expensive, even if the transition goes smoothly.

“I’ve been talking to folks at the conference, and they’re telling me that when they switch from version to version, not even CEHRT to CEHRT, there’s inevitably bugs, it slows productivity and they’re going back and forth with the vendor, he said.

Chasing every MIPS bonus isn’t always going to pay off. With the MIPS score on a 100-point scale, with limits on how high you can score in each of the categories—ACI, quality, improvement activities and cost—Tennant said adding a few extra points with incentives like the CEHRT bonus won’t be worth the investment if a clinician is already in line for a high score.

Other MIPS bonuses are offered automatically. For eligible clinicians at small practices—with 15 or fewer clinicians—five points will be added to their total MIPS score, which Marron-Stearns called “a drop in the bucket” considering the challenges for small providers to meet MIPS requirements.

“If you’re a five-doctor practice right now, the amount of effort you have to put in to score well in MIPS is challenging and you have to think really carefully about the (return on investment),” he said.

Small practices may be exempt from MIPS in 2018 if the raised low-volume thresholds in the proposed rule—$90,000 in Part B charges and treating fewer than 200 Medicare beneficiaries—are retained. Regardless of the small practice bonus, Marron-Stearns has encouraged clinicians near those thresholds participate in MIPS anyway in 2018 to avoid a “rude awakening” in 2019 when he expects those exemption levels to go down.