Medicare Incentive Program Too Complex, Advisors Say

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By Alex Ruoff

June 6 — Medicare's proposed new physician payment system is too complex for many doctors to understand, particularly the technology requirements, federal health IT advisors said recently.

The CMS needs to clearly define provider choices in the new system and what doctors must do to satisfy Medicare's new technology requirements and earn higher Medicare reimbursements, and avoid a reimbursement penalty, the quality payment program task force will tell the full Health IT Standards and Policy committees on June 8.

The committees are the main health technology advisory boards to the federal government.

“It is a complicated rule, especially if you're trying to calculate how performance might yield to payment adjustments,” Mark Savage, director of health IT policy and programs for the National Partnership for Women & Families, told Bloomberg BNA June 6.

The task force will present draft recommendations for the CMS merit-based incentive payment system (MIPS) proposed rule and advisors will issue a final report on suggested changes June 23.

The Centers for Medicare & Medicaid Services expects to publish a final rule in the fall. The MIPS program will replace several federal incentive programs for physicians and other health-care providers, including the meaningful use program.


The CMS proposed MIPS rule would offer doctors flexibility they've asked for by allowing them to choose how to meet various federal quality reporting and health IT requirements, Paul Tang, chairman of the task force, said during a June 3 meeting.

However, this flexibility would also create an “unwieldy” assortment of options that many doctors, particularly those in small practices, will struggle to navigate, Tang said.

Savage told Bloomberg BNA that the CMS did a good job of outlining some options in the proposed rule through tables and flow charts. He said the agency could simply offer more graphics illustrating providers' choices.


Members of the quality payment program task force also debated whether the proposed MIPS program would end the federal government's all-or-nothing approach to health IT requirements, which doctors have long complained about to the CMS.

Physicians' groups have said the meaningful use program was designed to punish doctors that fail only a few of its requirements. The program requires hospitals and providers to meet all requirements of the program to receive an incentive payment and avoid a Medicare reimbursement penalty.

CMS officials tout that the meaningful use program in MIPS will become the Advancing Care Information program and lose its controversial all-or-nothing approach starting Jan. 1, 2017, for physicians.

However, members of the task force argued June 3 that physicians participating in MIPS will still face an all-or-nothing system that requires them to meet a basic set of objectives or face a reduction in Medicare reimbursements.

“All-or-nothing isn't necessarily gone because they still have to meet a base score,” Tang said.

Savage told Bloomberg BNA he disagreed, saying that the basic objectives providers need to meet to avoid a Medicare reimbursement penalty are simple, and doctors just need to adopt a federally certified EHR system and demonstrate they've used it with at least one patient.

Task force members said the CMS should change how providers will be scored in the Advancing Care Information program to focus more on rewarding providers for taking on initiatives that matter to patients, such as improving safety and offering telehealth services.

To contact the reporter on this story: Alex Ruoff in Washington at

To contact the editor responsible for this story: Kendra Casey Plank at