What Is a Perfect MIPS Score Worth?

CMS ran its own quality program through a simulation this summer and printed the ceiling at 91 FR 44272. The most a MIPS eligible clinician can earn in the 2029 payment year, on a final score of a flat 100, is 1.34 percent.

The floor is negative 9.

The shape between those two numbers is the whole story (chart below).

Only One of the Nines Is Real

42 CFR 414.1405(c) sets the applicable percent at 9 for the 2022 payment year and every year after it. On paper that is symmetric.

The downside runs at full size. Score at or below one quarter of the performance threshold, which works out to 18.75 points against a threshold of 75, and the entire 9 comes off every Part B payment for covered professional services you furnish that year.

The upside gets the same 9 multiplied by a scaling factor whose only job is budget neutrality, and 414.1405(b)(3) lets that factor run as high as 3.0.

In CMS's proposed policies model for 2029 it lands at 0.149.

Fifteen cents on the theoretical dollar.

There is nothing else to pay a bonus with. Penalties are the entire funding source, and CMS's own payment adjustment user guide states the mechanic without flinching:

"When more clinicians receive a final score below the performance threshold, clinicians with a score above the performance threshold see a larger payment adjustment amount."

Your reward for a good year is set by how many of your peers had a bad one.