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Medicare’s congressional advisers Nov. 2 moved closer to recommending that the physician payment reporting system be ended, despite some dissension in their ranks.
Two of the 17 commissioners spoke against recommending repeal of the Merit-based Incentive Payment System (MIPS), which requires doctors to report quality measures to Medicare. The commissioners have been discussing a replacement system in which doctors are measured on quality standards as part of a large group.
Requiring doctors to come together in a large group in order not to be penalized financially is “significant social engineering in the structure of medical practice” without evidence of benefits, Commissioner David Nerenz said. Merely putting medical professionals together in a group doesn’t lead to good performance, he said at the Medicare Payment Advisory Commission’s November meeting.
The commissioners are expected to consider recommendations in December that would get rid of MIPS, which began Jan. 1. They believe the reporting system is expensive, complicated, and burdensome, and won’t achieve the goal of identifying and rewarding high-value clinicians.
“If it comes to us as a recommendation, I will not support it,” Nerenz, director of the Center for Health Policy and Health Services Research at the Henry Ford Health System in Detroit, said.
Commissioner Alice Coombs, a critical care specialist and an anesthesiologist at Milton Hospital and South Shore Hospital in Weymouth, Mass., said she sees value in reporting quality measures that can, for example, cut down on infections. “I want to go on record as against repealing MIPS,” she said.
A 2015 law, the Medicare Access and CHIP Reauthorization Act (MACRA), created a two-track doctor payment system. MIPS is one of the two tracks, but doctors may avoid it by joining the other MACRA track—an advanced alternative payment model. The models, which include some accountable care organizations, are intended to get medical professionals out of the Medicare fee-for-service system and into one that rewards quality, rather than volume, of health-care services.
If that’s the goal of MIPS, it’s already happening, Coombs said. She cited a study released Oct. 30 that said 29 percent of health-care payments were tied to alternative payment models in 2016 compared to 23 percent in 2015. The report was issued by the Health Care Payment Learning & Action Network (LAN), a public-private partnership intended to drive adoption of the models.
However, MedPAC staff and most of the commissioners believe that MIPS has not been proven to be linked to high-value care. Many of the MIPS quality measures are process-oriented, and some are attestation only or “check the box,” staff said.
The system the commissioners are expected to vote on in January 2018 as a replacement would withhold 2 percent of a clinician’s Medicare reimbursements. Withheld funds would be returned to clinicians if they join an advanced alternative payment model. If they join the new large group system, known as the voluntary value program, they would qualify for a bonus payment. This would be based on the group’s performance on a set of population-based measures, patient experience, and costs. If they don’t join the model or the large group, they lose their 2 percent.
The groups under the proposed voluntary value program would need a minimum of 10 clinicians to measure members on such items as avoidable admissions and emergency department visits, staff said.
Commissioners Craig Samitt, Jack Hoadley, and Rita Redberg were among those who said they favor the recommendations. MIPS “doesn’t get us where we want to go,” Redberg said.
However, Mara McDermott, vice president of federal affairs for CAPG, said during the public presentation segment of the meeting that it’s premature to end the current system. “We have concerns about throwing it out at the moment,” she said. “We think there is value in having some reporting,” she said. CAPG members represent medical groups and independent practice associations that operate under managed care.
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