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MIPS: Ophthalmologists filing as individuals may be missing out

Posted on April 15, 2022

According to a JAMA Ophthalmology study analyzing MIPS performance and related payment adjustments for ophthalmologists participating in the 2019 Quality Payment Program (QPP), filing as advanced alternative payment models (APMs) or group was associated with achieving exceptional MIPS scores resulting in an additional payment per participant.

Of the ophthalmologists registered for Medicare, 76.5% of ophthalmologists (13,621) participated in the MIPS pathway of the QPP for the performance year 2019, with the majority (90.3%) practicing in predominantly large metropolitan areas.

Approximately 99% of participants received nonnegative reimbursement adjustments, with 92.6% receiving positive adjustments.

Compared with ophthalmologists filing as individuals, exceptional performance scores were more likely to be achieved in those filing as APM (odds ratio [OR], 0.0003; 95% CI, 0.00002-0.00481) or group (OR, 0.21013; 95% CI, 0.19020-0.23215).

Of the 11,193 participating ophthalmologists with available Medicare payment data, 78.4% (8777) achieved exceptional MIPS scores corresponding to mean (SD) adjustments per physician of $244.60 ($217.36) to $4864.78 ($4323.08), or 0.07% ($2 146 835.21 of $3 212 011 252.88) to 1.33% ($42 698 166.89 of $3 212 011 252.88), of the total nondrug Medicare payment.

Reference
Berkowitz ST, Siktberg J, Gupta A, et al. Economic Evaluation of the Merit-Based Incentive Payment System for Ophthalmologists: Analysis of 2019 Quality Payment Program Data. JAMA Ophthalmol.  doi:10.1001/jamaophthalmol.2022.0798

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