Introduction
Practices are facing a Medicare revenue threat that becomes visible only after it is too late to correct. The 2026 Quality Payment Program can reduce future reimbursement through MIPS penalties, even as fee schedule shifts compress margins. This paper explains where the exposure begins, why smaller practices are hit harder, and what leaders must do now before loss becomes unavoidable.
Key Takeaways
- The 2026 MIPS performance threshold remains at 75 points for eligible clinicians
- Scores at or below 18.75 points trigger the maximum 9% payment penalty under MIPS
- A $500,000 Medicare practice can lose $45,000 in one payment year
- 2026 MIPS performance determines Medicare reimbursement two years later in 2028
- 49% of solo physicians received MIPS penalties in the 2025 payment year
- Practices spend $12,811 per physician annually on MIPS-related compliance work
- MIPS activities consume 201.7 hours per physician each year across practice teams