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Congress’s Medicare advisers Oct. 5 appeared close to recommending that the nine-month-old physician quality reporting system be killed.
The Merit-based Incentive Payment System, known as MIPS, is extremely complex and a $1 billion burden on doctors, staff of the Medicare Payment Advisory Commission said during a presentation at the panel’s October meeting.
No recommendations have been drafted, but the commissioners will continue discussions on MIPS at their December meeting, Commission Chairman Francis J. Crosson said. Action is needed quickly, Catherine Bloniarz, a MedPAC senior analyst, said, because the Centers for Medicare & Medicaid Services begins making MIPS adjustments to doctors’ payments in 2019, based on performance in 2017.
The commissioners appeared to be in agreement that MIPS, which began Jan. 1, needs to go, but there wasn’t a consensus on what system, if any, should replace it. Eligible doctors who don’t participate in advanced alternative payment models report quality measures under MIPS and results can raise or lower Medicare reimbursements based on scores.
However, MIPS “will not achieve the goal of identifying and rewarding high-value clinicians,” David V. Glass, a MedPAC principal policy analyst, said during the presentation. MedPAC makes recommendations to Congress and the CMS on Medicare policy, and lawmakers would have to change federal law to get rid of the reporting program.
A 2015 law, the Medicare Access and CHIP Reauthorization Act (MACRA), created a two-track system when it replaced the sustainable growth rate formula as the Part B payment methodology. 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.
MACRA affects hundreds of thousands of professionals, but 800,000 are currently exempt for various reasons, including having a low volume of Medicare claims.
The Centers for Medicare & Medicaid Services offers professionals a wide range of MIPS measures on which to report. But since they can choose their own measures, comparisons are difficult. The measures themselves are not associated with high-value care, staff said.
Nearly all of the commissioners said that MIPS should either be repealed, or repealed and replaced.
“It’s a huge pain” and should be ended, Commissioner Rita Redberg, a professor of clinical medicine at the University of California at San Francisco Medical Center, said. People don’t go into medicine to check off boxes, she said.
“When I think of all the money that we pay to reward clinicians for their participation, I don’t think we’re getting value,” Commissioner Dana Gelb Safran, the chief performance measurement and improvement officer for Enterprise Analytics at Blue Cross Blue Shield of Massachusetts, said. The Medicare patient is not going to be getting better quality care or better outcomes as a result of MIPS, she said.
Commission staff discussed as a possible replacement a program in which doctors would have a portion of their Medicare fee schedule payments, suggested at 2 percent, withheld. They could then choose to join an alternative payment model and get the money returned.
They could also be measured on performance as part of a large group of clinicians. The measures would examine clinical quality, patient experience, and value. Medicare would be able to adjust funding for group members based on outcomes. But if doctors do nothing, they lose the withheld funds.
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