SGR Fix Folds MU Penalties into MIPS

 - SGR Fix Folds MU Penalties into MIPS

Two aspects of the SGR Repeal and Medicare Provider Payment and Modernization Act of 2014 have been widely reported in the radiology press; the requirements that physicians consult appropriateness criteria prior to ordering high-tech imaging; and CMS disclose the source of the data on which the decision to apply a 25% multiple procedure payment reduction was based.

Less has been said about the language in HR 4015/S 2000 that would eliminate penalties for eligible professionals who fail to comply with meaningful-use criteria by 2017. However, physicians should keep the cork in the champagne bottle.

The program is not going away: Penalties will be replaced by the Merit-based Incentive Payment System (MIPS), which, along with PQRS and the value-based modifier, will kick in beginning January 2018.

Physicians will earn MIPS positive and negative provider payment incentives based on the following four areas: meaningful use (25%); quality (30%), resource use (30%), and clinical practice improvement (15%).

According to a fact sheet on the HIMSS web site, payment penalties will be limited to no more than 4% in 2018 under MIPS, 5% in 2019, 7% in 2020, and 9% in 2021. Under this formula, failure to comply with MU could result in penalties of us up to 2.3% in 2021.

In an interview posted on the Modern Healthcare blog, former head of the Office of the National Coordinator, Farzad Mostashari, MD, throws his support behind the bipartisan, bicameral legislation to replace the SGR, noting that the incentives will stay in place.

“The carrots are renewed in a sense, because it's part of the value-based purchasing model,” he told the writer. “Meanwhile, CMS will continue to determine meaningful use, which becomes a component of MIPS.”