MACRA, MIPS and Quality Metrics


At The Ghosh Center, providing you with the best care is our highest priority. We measure how we’re doing in a number of ways – from patient surveys about your experience to participation in clinical certification programs like QOPI®.

And now we have a new yardstick, courtesy of our friends in Washington: MIPS, which stands for Merit-Based Incentive Payment System.

Value Over Volume

A little history: In 2015, Congress approved a new law designed to improve care for Medicare patients by changing the formula used to reimburse physicians. This law, called MACRA (the Medicare Access and CHIP Reauthorization Act), moved payments away from a fee-for-service model to one that rewards physician performance.

In simple terms, the reward system shifted from volume to value. The old formula paid physicians based on the number of services they performed (volume). The new formula reimburses doctors based on the quality of their services (value). It’s intended to be a win/win. Patients have the potential for better outcomes; providers have the prospect of higher payments for Medicare Part B services.

How MIPS Works

MIPS scores are calculated in four categories: quality, cost, improvement activities and promoting interoperability.  The graphic below shows how the categories were weighted in 2018.

Source: Centers for Medicare & Medicaid Services –

In this model, quality is a big piece of the equation. We’re required to track and report data based on a variety of quality measures. An example of this would be our efforts to assess and manage patients’ pain levels. We’re also scored on how efficiently we deliver services, our efforts to improve and integrate care and the effectiveness of our electronic health record system.

Our Results

We’re pleased to report that out of 100 possible points, we scored 97. Our score was based on three months of data from 2017, the first reporting period for the new Merit-based Incentive Payment System. We submitted this performance data to the Centers for Medicare & Medicaid Services (CMS) in March of 2018. Because payment adjustments lag by two years, in 2019, we’ll receive a positive adjustment in the Medicare payments for Part B services that were performed in 2017.

The Ghosh Center scores 97 out of 100 points.

Top performers receive higher reimbursement levels. If scores fall below a certain threshold, providers are required to repay a percentage of the Medicare Part B reimbursement they received. Those who don’t participate in MIPS or an alternative payment track can be penalized.

A significant portion of the incentive pool comes from the penalties applied to poor performers, creating a strong incentive for those falling behind to make improvements.

What’s Next

We’re hard at work tracking and recording 2018 data for submission to the CMS. And by we, we mean Mindy, so if she looks a little glassy-eyed, you might want to be extra nice to her.

We’ll keep reviewing our performance against our own high standards and exploring ways to do even better. Success in MIPS requires an organization-wide commitment toward continuous performance improvement. We’re all in, and, as always, will keep you posted on results.