Certain practices affected by Texas’ statewide winter storm won’t have to submit data for Medicare’s Merit-Based Incentive Payment System (MIPS) for 2021.
They can if they want, though – and take a gamble on getting either an incentive payment or a penalty.
The Centers for Medicare & Medicaid Services (CMS) announced that its “extreme and uncontrollable circumstances” policy will apply automatically to MIPS-eligible clinicians in federally declared Texas disaster areas as a result of the February storm, which includes all 254 Texas counties. The agency said the policy won’t apply to clinicians participating in MIPS as a group or virtual group, or through an alternative payment model.
CMS will automatically identify clinicians in the disaster-designated areas and assign them a “neutral payment adjustment” – MIPS-speak for no change in payments – for the 2021 performance year (affecting payments in 2023). All four performance categories for MIPS will automatically be weighted at 0%, meaning affected participants will be scored right at the performance threshold – no extra payment, no penalty.
However, practices confident they can overcome February’s historic disruption and perform well in MIPS this year have the option of going for it. MIPS-eligible clinicians in the disaster areas may choose to submit data in two or more performance categories and receive a score. In that case, you’re eligible for an incentive payment – or a penalty if you fall short of the performance threshold.
TMA staff says the policy will be welcome news for most small practices. However, it could frustrate larger practices that made time and staff investments geared toward excelling in MIPS. The announcement prompts practices to make a strategic risk/reward decision on whether to participate in a notoriously complicated quality program.
Houston internist Lisa Ehrlich, MD, told Texas Medicine Today that her three-physician practice lost power for several days. While the practice didn’t lose any data, it did lose its internet server and four days of work, requiring a technology infrastructure rebuild and an estimated $20,000 hit.
“We stay on top of it as we go along. We usually get our incentives. But I’m not sure how this is going to play out,” Dr. Ehrlich said. “Because we didn’t lose any of our data, I think we’ll probably be fine. Financially, it costs money to get all the third parties to do … all of the things that we need for the regulations to get that MIPS incentive. If it looks like we’re not going to [score well in] MIPS, then we can probably just take that neutral [adjustment] and not spend a whole lot of money on the third party that usually helps us to get the incentive every year.”
CMS has invoked the extreme and uncontrollable circumstances policy multiple times since MIPS’ launch in 2017, including for Hurricane Harvey, wildfires, and COVID-19.