Physician Reputation and the MIPS Composite Score
Providers, the reputational impact of MIPS is a bigger deal for you than the financial one. Your ability as a clinician is going to be distilled into a single number, 0 to 100, the Composite Performance Score (CPS). It will be your grade. A 100 CPS is like a 4.0 GPA.
You will be branded. Your score will stay with you for two years. Wherever you go, and whomever you work for, no matter what you change, it is yours. Your score makes it very easy to rank you against your peers. Potential patients will not care very much that the score has limited evidence correlating it to outcomes that matter. It is an easy button, and easy buttons these days tend to win out over reason.
There is an exception to the individual score; you could be branded with the number your group earns together (i.e. your ACO). I hope your team is good.
You are supposed to have a choice which way to be scored – as a group or individually. In most cases, the individual provider is not choosing, management is. Because the administrative reporting burden for MIPS will be painful for the management team, they will want to report you as a group. Group reporting is easier. It is another easy button.
Management will be most worried about the potential financial impact of MIPS. You should be more concerned about your reputation. Your brand (score) will be public. It will be promoted on multiple social media rating sites, like Yelp. Anyone who wants to will know your CPS number.
Your CPS number is your reputation.
Here are just a few scenarios to consider:
1) Your score is high: You will be wanted. Payors, ACO’s, patients, and recruiters will seek you out. You are now a star athlete. Many will want you on their team. Your score is likely the composite result of you and your strengths combined with the team around you, the culture of improvement you are embedded in, and some insights generated by reasonably actionable data. Share a little gratitude with your team. I know you will.
2) Your score is average: You were likely scored as a group. You are part of the huddled masses. You have been regressed to the mean. As better optics are gained on who has the low MIPS composite scores within the group, the low scorers will face fierce, focused attention from their peers. Because team cohesion is known to be correlated to patient safety, the internal group discord created by the reputational branding of providers will undermine high-quality patient care. Decreased quality of care will be an unintended consequence of the composite performance score in groups where discord occurs.
3) Your score is low: You wear a Scarlet Letter. Patients will avoid going to you. Payors may drop you from their preferred networks. Your peers may kick you out of the ACO. Recruiters will not engage with you. Hospitals will be reluctant to bring you onto their medical staff. As Benjamin Franklin said, it only takes one bad ‘deed’ to lose your reputation. In this case, that ‘deed’ is going to be your composite MIPS score. Advice: Figure out how you are being graded and act on that knowledge. If you are in an environment where there are limited resources and knowledge about performance improvement, consider advocating for more help. It is the responsibility of the administration to surround you with the culture, tools, team, training and resources required to support continuous improvement. If your score is low, and you have been provided what you need to succeed, and you have not taken these things seriously, your reputation is in serious trouble, and once it has gone, it is difficult to get it back.
All of this is, of course, is as designed. CMS wants the intense peer pressure applied to the “underperformers.” In the face of this reality, I will leave my colleagues with this ancient proverb:
“A good name is more desirable than great riches; to be esteemed is better than silver or gold.” ~ Proverbs 22:1
Pay attention to your composite score. Your reputation depends upon it.
For more on MACRA, MIPS, and APMS, here are a couple of resources for you: