Perfect MIPS Score Leads to Positive Medicare Reimbursement Adjustment for MaineHealth ACO Providers

August 29, 2019
CMS (Centers for Medicare and Medicaid Services) recently announced that participants in the MaineHealth ACO earned a perfect score of 100 for MIPS (the Merit-based Incentive Payment System) in 2018, resulting in a 1.68 percent increase in their Medicare Part B professional service reimbursement rate beginning in 2020. MIPS is a risk-based program that can result in either a negative or positive reimbursement adjustment, based on provider performance on utilization and quality measures.

“Securing a positive adjustment based on stellar performance is a tremendous result,” says Betsy Johnson, MD, MS, FACP, president and CEO of the MaineHealth ACO. “Increases in reimbursement can mean more resources for practices and their population health efforts, an outcome that the ACO welcomes. But of course, our perfect score represents more than a financial gain. It reflects providers’ and care teams’ sincere dedication to high quality care and suggests that more patients are getting the right care, at the right place at the right time. The performance of every provider in the ACO contributed to this score. They can be proud of what they achieved individually and what their ACO network of 1,600 providers achieved together.”

The MIPS score was determined by analyzing aggregated performance data in three categories: Quality, Clinical Practice Improvement Activities and Promoting Interoperability. By virtue of participation in the MaineHealth ACO, providers earned full credit in the improvement activities category and had their MSSP (Medicare Shared Saving Program) quality performance data automatically applied to the MIPS quality category.

Our performance highlights include a 30 percent increase in post-discharge medication reconciliation, a six percent increase in colorectal cancer screening and a high decile performance in diabetes control and tobacco intervention.

More information about MIPS is available on the provider resource page of the MaineHealth ACO website (www.mainehealthaco.org).