New Doctor Payment System Poses Challenges for Medicare

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By Mindy Yochelson

The Medicare agency deserves a pat on the back for laying the groundwork for doctors’ new quality-based payment system, but it still needs to tackle two main areas in the new year, a government report said Dec. 21.

Adequate technical assistance must be offered so doctors, particularly those in small or rural practices, are ready to participate in the quality payment program (QPP) under the Medicare Access and CHIP Reauthorization Act of 2015, as it starts up Jan. 1, the Health and Human Services Office of Inspector General said.

The agency also faces challenges in developing IT systems that support and streamline clinicians’ participation, the report said.

The program’s goal is to base physician payments on quality of performance. Doctors must choose whether to participate in the program by reporting quality measures or by joining an advanced alternative payment model. Their performance in 2017 will affect their Medicare payments in 2019.

If they don’t participate in 2017, they will get a 4 percent cut in their reimbursements in 2019.

Big Demand

In 2017, the Centers for Medicare & Medicaid Services will face an increased demand for information as well as feedback from clinicians who are new at reporting, the OIG said.

The first year of the program, known as “pick your pace,” was designed to ease doctors who may be skittish about reporting into the program with limited requirements. However, while “this is likely to initially encourage clinician participation, CMS may face resistance in future years as the program requirements become more stringent,” the report said.

To achieve its goals, the CMS will need to sustain its clinician engagement efforts, the report said.

“CMS has begun its technical assistance and training efforts, but these activities must quickly be ramped up to full scale and continued throughout 2017 to support Medicare clinicians’ participation,” it said.

Areas of Concern

The report “shines a spotlight on two ongoing areas of concern for physician group practices as they prepare for the major transition” to the new program, less than two weeks away, Jennifer McLaughlin, a senior associate director for the Colorado-based Medical Group Management Association, told Bloomberg BNA. The group represents practice administrators.

First, physicians and group practices must proceed without critical information, she said. Doctors still need to know “how to successfully demonstrate and attest to improvement activities” under the new reporting program, the Merit-Based Incentive Payment System (MIPS), McLaughlin said. So far, there has been little information released “about how to ensure completion of the activity, document it, and then attest to it,” she said.

Second, the CMS has not yet unveiled the systems for submitting reporting data and accessing feedback, she said.

“CMS must still expand its technical assistance efforts, issue promised subregulatory guidance, award and oversee key contracts, and complete development of backend IT systems necessary to support critical QPP operations,” the report said.

The MGMA has urged the CMS to extend the “pick your pace” transition period through 2018 to allow the agency more time to address these issues and provide for a much smoother transition, McLaughlin said.

Watchdog Agency

“It’s valuable that the IG is keeping an eye on the CMS as it enters the implementation phase,” Thomas Gustafson, a senior policy adviser with Arnold & Porter in Washington, told Bloomberg BNA.

“There’s more to be done” but it appears that the agency is approaching its task “with a fair amount of thoughtfulness and vigor,” he said.

However, the CMS needs to work on its IT system so it doesn’t repeat problems from the past, he said.

MIPS is a combination of previous clinician reporting programs, such as the Physician Quality Reporting System.

Based on his experience with the former programs, Gustafson said, the CMS needs to develop its IT system so that it forgives clinicians’ "errors or missteps” when they’re sending data.

Doctors shouldn’t be penalized if they press the wrong button, Gustafson, a former official with the Medicare agency, said. The agency “has not always been able to accommodate those kinds of snafus in its system.”

Agency Response

The CMS said it has launched a website that explains the program and helps professionals identify the measures most relevant to their practices. The agency is conducting “extensive user testing” of the site so the information is understandable, acting Administrator Andy Slavitt said in Dec. 1 comments included in the report.

In addition, the CMS recently “added a tool to share electronic data that makes it easier for other organizations to retrieve and maintain the quality payment program’s measures,” he said.

To contact the reporter on this story: Mindy Yochelson in Washington at

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

For More Information

The report is at

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