The law that put nine percent of a doctor's Medicare pay on quality scores
The 2015 MACRA statute created MIPS and set the payment adjustment at four percent for 2019, rising to nine percent from 2022, in both directions, on Medicare Part B pay. Depression screening and remission are among the measures.
We have not finished checking this source. No judgement either way. how we score evidence
Caveat on this rating: The plus-or-minus nine percent is a ceiling, not a typical outcome; realised adjustments are smaller and budget-neutral. No per-clinician depression-measure figure exists in any record we read.
Significant findings
The Medicare Access and CHIP Reauthorization Act of 2015 replaced the old formula for physician pay with the Merit-based Incentive Payment System. The mechanism is in the statute itself, in section 1848(q)(6) of the Social Security Act: each year a clinician's Medicare Part B payments are adjusted by an "applicable percent" which the law lists as "for 2019, 4 percent; for 2020, 5 percent; for 2021, 7 percent; and for 2022 and" each year after, 9 percent. The adjustment runs both ways: a clinician below the threshold gets "an adjustment factor of the negative of the applicable percent." Positive adjustments can be scaled up for budget neutrality, but "In no case may the scaling factor applied under this clause exceed 3.0."
CMS sets the line each year in rulemaking. The 2026 final rule fact sheet states the performance threshold "at 75 points through the CY 2028 performance period/2030 MIPS payment year." Score above 75 and the adjustment is positive; below it, negative. The depression screening measure and the depression remission measure are among the quality measures a clinician can choose to be scored on.
Worth asking
This is the money behind the tablet, and it is worth being precise about its size. Nine percent is the statutory ceiling in either direction, applied to Medicare Part B payments only. The programme is budget-neutral, so most clinicians land near zero. What the record does not contain is any per-clinician figure for depression measures specifically, and this row does not invent one.
Source
Medicare Access and CHIP Reauthorization Act of 2015, Public Law 114-10, section 101(c): Merit-based Incentive Payment System — United States Congress (2015)
Read the source: https://www.govinfo.gov/content/pkg/PLAW-114publ10/html/PLAW-114publ10.htm
How this was scored
- Study design
- not recorded
- Funding
- not recorded
- Published in
- not recorded
- Sample size
- not recorded
- Preregistered
- not recorded
- Conflicts disclosed
- not recorded
- Independent of proponent
- not recorded
- Retracted
- No
We have not finished checking this source, so there is no scoring to show yet. “We have not checked this yet” and “this is disputed” are different statements, so no scored band is shown rather than a low one.
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Published September 17, 2026.
Questions
How strong is the evidence behind this?
veisund rates this source "not yet assessed". We have not finished checking this source. No judgement either way. One caveat travels with that badge: The plus-or-minus nine percent is a ceiling, not a typical outcome; realised adjustments are smaller and budget-neutral. No per-clinician depression-measure figure exists in any record we read. The score is calculated from recorded facts about the source — study design, funding, publication venue, sample size, preregistration — not typed in by an editor.
What is the source for this?
Medicare Access and CHIP Reauthorization Act of 2015, Public Law 114-10, section 101(c): Merit-based Incentive Payment System — United States Congress (2015). The full source is linked on this page so you can read it yourself.
Is this medical advice?
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.