MIPS: We’re All Losers

I can’t believe MIPS (Merit Based Incentives Payment System) still exists. Quality metrics continue to fail because there is no true way to define quality. Did you see the study where they used “time with patient” as a quality metric? No? That’s because it will never be done.

But back to MIPS. This just came out:

The agency said 97.6% of clinicians who participated in MIPS last year will receive a positive payment adjustment on each of their Medicare Part B claims in 2020, which is slightly higher than 2017 when 93.1% of clinicians got a bonus last year. At the same time, the number of participants in the program dropped from 1.06 million to 916,058.

Remember, getting these positive payments is a game. Why? Because the stupid thing is budget neutral:

Those who receive higher scores get a higher payment adjustment. However, it’s unlikely clinicians will see substantial bonuses next year because the program is budget neutral and therefore relies on the pool of penalties to dole out the bonuses, Drevna said. Just 1.95% of clinicians received a penalty. The CMS can penalize clinicians for up to 5% of their Medicare Part B payments.

I get it. Docs are stuck in the system and see no choice. But all this MIPS crap changes how you practice medicine. It is like teaching to the test. And do you believe it is helping patients more? MIPS is not why you became a doctor. Find a way to break free and practice authentic medicine again!

P.S. If you click the link you will see the stock picture they used from Getty Images. Yeah, like these MIPS doctors are writing on paper. Ha!

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  6 comments for “MIPS: We’re All Losers

  1. sean
    July 20, 2019 at 1:01 am

    MIPS, NPS, etc. all of these metrics along with the over empowerment of patients is destroying medicine. Providers are just waiters/waitresses (with no offense to waiters/waitresses) working for tips. Doctors are smart people who worked hard to get into a top profession and once in are trapped. They are trapped by the desire to have a good life style, to pay their bills and practice what they trained a decade and a half for. Gotacha!! Is how it really is.

  2. John A Goldman, MD
    July 17, 2019 at 8:58 pm

    MIPS criteria barely scratch the surface. Care for our patients is what we do but what we really do is not covered by MIPS. There are few measurements that they are using that are and there are many they are using that are contributing to burnout. The Burnout is EHR directed, wasted time, the results of the Dartmouth Study 2 hours more a day and taking home unfinished work; ruining live-work healthy family time. You are told get a scribe – why do I have to get a scribe. If EHR was so good there would be no need for a scribe. You need a scribe to avoid the misery of unworkable EHR. So let me get this right “EHR is great for medicine, but you need a scribe to make it great”. Add another $1600/month or more to make EHR great for medicine. Thanks! The AMA is still studying EHR even though their own Rand sponsored study from 2014 showed how bad they were. The AMA does not care – why? only 22% of US physicians are members, a recent AMA president did not use EHR, another tired to change it but he was rebuffed by his attempt to change it because AMA money doe not want to remove EHR. Their money is CPT etc. Even more ironic is when Seema Verma, MD head of HHS spoke at the Annual AMA meeting in June 2019 and she told us they know the Health care in this country is a mess and they know it is bad, very bad and discussed many ways it is terrible but offered no way to improve it. I tired to get a true copy of her speech on the AMA website but what is there is incomplete.

  3. Bill
    July 17, 2019 at 4:53 pm

    MIPS CAUSES physician burnout

  4. Randy
    July 16, 2019 at 3:23 pm

    Recall that when the MIPS program was being proposed and in the comments phase, it was estimated by CMS itself that 90% of solo physicians would “flunk” and have to pay a penalty. They have made it easier and funded programs to help solo physicians, but I still see physicians saying they won’t participate due to the time and expense.

    To me one of the biggest determinants in whether a physician can successfully navigate MIPS is still if he/she is in a group big enough to hire an employee to figure it out for them.

  5. Bridget Reidy
    July 16, 2019 at 12:47 pm

    I don’t know much about how these ideas are being implemented today. But considering that the great deal of work we do in primary care to prevent hospitalization or rehospitalization is otherwise thankless and unpaid, I’m all for changing that. Even more, I’m all for having a health system with the same goal instead of one nixing all my efforts. American Acedemy of Home Care Physicians and the VA proved the concept for the homebound over ten years ago, cost efficient and good care, Maybe it should only be applied to the frail with controls against cherry picking. Paying us for our time however we see best of course would be a better alternative free of the cherry picking problem, but won’t do anything to get the health system to work with us on these issues.

  6. Steve O'
    July 16, 2019 at 8:57 am

    Systems exist with quality metrics for the purpose of demonstrating failure. NO medical quality metric system can show broad-spectrum success, and isolate and remedy the rare failures. Such systems treat the “practitioners” as their clients. That is not the intent of medical quality metric systems.
    The question they are seeking is justification for mistreating individual doctors. Every form of bigotry, racism, sexism and discrimination seeks the same justification.
    They form a grotesque parody of the concept that competition, no matter what, leads to excellence. It was peddled to the doctors-to-be in “premed” programs, and residency programs, and all other forms of servitude in medicine. You can see this pretense in all form of slavery throughout history. Divide and rule! Get them fighting against themselves!!

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