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Miffed About MIPS

By Sharda Kohli

In July 2019, our institution received our 2018 MIPS Feedback Report from CMS. 

We had worked very hard throughout 2018 to achieve a score of 100 points. We worked with a consultant who assisted with our submission. We spent countless person-hours reviewing data from Aria’s Quality dashboard as well as manual data pulled for measures that didn’t flow into the quality dashboard. We worked with our IT team to pull data from various clinical practice sites with different versions of Aria, none of which were on the same server. We met with our clinical care team for repeated trainings on how and where to put data: which box should be checked and when. We even hired a part-time student to help with our audit process.

And then in July we received our Feedback Report and learned that our positive payment adjustment was 1.68 percent, for a score of 100 points. A perfect score. Unfortunately, the actual dollars that we will receive in 2020 for our perfect score will not reimburse even a fraction of the resources that were used. 

Recently a friend shared with me an article (“‘Meticulous’ study shows that value-based care works”) about a study that was recently published in the New England Journal of Medicine validating that value-based care works. What was absent from the article (disclaimer:  I didn’t read the actual study) was any discussion about the costs that organizations incur in order to demonstrate value.  For us, it was the cost of our consulting agreement, approximately 0.4 FTE of a staff member, a part-time student, roughly 0.2 FTE of IT support, plus fringe and overhead. These are the obvious costs that pop out at me. I am sure there are others. 

As my organization shifts to discussions about participation in the radiation oncology alternative payment model (RO-APM), I am worried about the costs of meeting this new mandate. If our country is serious about a value-based payment system for health care, we must make sure that the total cost of delivering and demonstrating value is part of the equation.


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