Payment variability predicted to grow for physician specialists

Physician specialist payments could vary as much as 29% by 2020 under the Merit-Based Incentive Payment System (MIPS), according to the October 5 press release by Avalere. This is due to CMS’s proposal to include Medicare payments for Part B drugs in the calculation of the MIPS payment adjustment. If the proposal goes through, certain specialists may be looking at significant payment adjustments with a potential decrease or increase of 16% for 2018 MIPS performance, according to the press release.

“Certain specialists administer more Part B drugs than others and, therefore, may be exposed to significant financial risk and payment swings year-over-year under the CMS proposal,” stated John Feore, director at Avalere, in the press release. “If the proposal is finalized, these specialists could see substantially higher payment penalties or rewards than their counterparts who administer fewer Part B drugs.”

For maximum MIPS payment adjustment for performance year 2018 under CMS proposal, Avalere predicts a payment variance of:

• 16% for rheumatology, hematology/oncology, and medical oncology
• 7% for ophthalmology and allergy/immunology
• 6% for urology and neurology
• 5% for internal medicine and general practice

The company predicts the payment variance will continue to grow. For maximum MIPS payment adjustment for performance years 2020 and beyond, Avalere predicts a payment variance of:

• 29% for rheumatology, hematology/oncology, and medical oncology
• 13% for ophthalmology
• 12% for allergy/immunology
• 11% for urology and neurology