MIPS exceptional performance bonus: how much could you earn?

MIPS bonus

The exceptional performance bonus in MIPS is a pool of $500 million reserved for top MIPS performers. The majority of MIPS is budget neutral, which means that the money providers lose in penalties will be used to pay those who earn incentives. The bonus pool, however, is not budget neutral, meaning that it is a set amount that will be paid out to top performers regardless of how everyone else does. So, what does it mean to be a top performer, and is it worth going for this bonus?

What is an exceptional performer in MIPS?

To be an exceptional performer in MIPS, you must earn 70 out of 100 points in your Composite Performance Score. This 70-point threshold applies in both 2017 and 2018, and may shift in 2019.

Remember, your Composite Performance Score is calculated from a combination of your points earned in each performance category. You can review the overview of performance categories and scoring here.

How much could I earn?

Let’s do a simple bit of math to understand what you may earn in different scenarios. Keep in mind that your bonus payment will depend not only on whether or not you meet the 70 point exceptional performance threshold, but also how well you do above that threshold. In other words, higher performing clinicians will get more of the $500 million pie. For now, let’s take a look at the average earning for exceptional performers.

Though the exact number varies by source, let’s assume that about 400,000 clinicians are eligible for MIPS in 2017. If 25% of these hit “exceptional performance,” then 100,000 clinicians would be eligible for the exceptional performance bonus, and each eligible clinician (EC) would receive $5,000 on average (remember, this number will vary based on how well you perform above 70).

Therefore, a group with 50 ECs would stand to gain over $250,000 in exceptional performance bonuses.


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So is it worth it?

It depends on your goals, but the size of the bonus incentive available may justify a small additional investment to get your score up over the threshold. Some analytics tools, like Able Health, can help you increase your score just using the data you have, without changing workflows. These low hanging fruit improvements provide a clear ROI when they get you up over the 70 point threshold.


Have questions? Email us at hello@ablehealth.com

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Further reading:
6 ways to improve MIPS quality performance with the data you already have
Submitting MIPS through the new CMS website: what it can and can’t do

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