Doctors’ Medicare Payments: Back to the Drawing Board?


It only took about a dozen years of congressional attempts to replace the old sustainable growth rate (SGR) system that had plagued doctors with annual sharp cuts in Medicare payments.

When Congress finally did pass the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), the sound of champagne corks popping could be heard throughout the land (or at least in medical and lobbyists’ offices).

MACRA offered payment increases for doctors for the first five years and created a two-track system: Join an advanced alternative payment model or be part of the quality scoring system, called the Merit-Based Incentive Payment System (MIPS).

Although it just began Jan. 1, some cracks are already starting to appear in the new MIPS system. And Congress’ Medicare advisory panel is identifying some irksome issues with the new formula.

“We don't expect that MIPS will be able to identify high- and low-value clinicians and will not be useful for beneficiaries, clinicians or the program,” staff for the Medicare Payment Advisory Commission said in early March.

MIPS uses hundreds of clinician-reported quality measures. But each clinician is judged by his or her own measures so scores aren't comparable, MedPAC staff said.

In addition, MIPS doesn’t distinguish between high performance and low performance, and it’s very complex, staff said.

MedPAC ideas for fixes include transferring a $500 million MIPS “exceptional performance bonus” fund from MIPS to the advanced alternative payment model track, tempting medical professionals to join a model.

I expect more ideas on fixing MIPS from MedPAC later this year.

Read my full article here.

Stay on top of new developments in health law and regulation with a free trial to the Health Law Resource Center.

Learn more about Bloomberg Law and sign up for a free trial.