Most anesthesiologists and other physicians and health care providers entered the Quality Payment Program (QPP) through the Merit-based Incentive Payment System (MIPS) pathway. In these first years of MIPS, the amount of risk started out low, and the performance score necessary to avoid a negative adjustment was within the reach of most everyone. That was especially true in the first year of the program under the “Pick Your Pace” option. Now in the third year of the MIPS program, we need to prepare for the end of the “on ramp” that was intended to ease the way into the program and to ensure successful participation.

For the 2017 performance year/2019 payment period, the percent of payments at risk under MIPS was 4 percent and the score needed to avoid a negative adjustment was three points. In the 2019 performance/2021 payment period, payment risk is up to 7 percent and the...

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