Which Reimbursement Path Will Doctors Favor Under Medicare’s New Payment System?


It won’t be the new Merit-Based Incentive Payment System (MIPS) that’ll attract most doctors under the so-called “doc fix” law that replaced Medicare’s notorious sustainable growth rate (SGR) formula, an official with a physician managed care organization predicts.

The Medicare Access and CHIP Reauthorization Act of 2015 offers providers a choice of two reimbursement paths beginning in 2019.

For one, physicians and other Part B medical professionals may choose to be reimbursed under MIPS, a “fee-for-service plus quality link” in which Medicare payments will be adjusted based on performance measures to be developed over the next few years.

MIPS will replace the current group of incentive payment programs: the Physician Quality Reporting System, Value-Based Payment Modifier, and Electronic Health Records Meaningful Use Incentive Program. Each year, there’s the potential to either gain or lose a percentage of payment, starting with 4 percent in 2019 and growing to 9 percent in 2022.

Despite the opportunity to get a significant bonus, Mara McDermott, a vice president at CAPG, told her members during an Aug. 27 webinar that she believes the more popular choice for Part B providers will be to become part of an alternative payment model (APM), such as an accountable care organization (ACO) or other risk bearing organization like a medical home. Those who do,  are exempted from being scored under MIPS and also receive a 5 percent annual bonus.

CAPG’s experience with the current batch of quality programs and the complexity of new programs “causes us to be skeptical” that doctors will flock to MIPS, she said. Except for high achievers, providers will find the certainty of the APM model and its steady 5 percent adjustment, the more attractive of the two paths, she said.

While ACOs and medical homes most commonly come to mind as APMs, McDermott foresees new models emerging before 2019. Much will rest in the hands of the 11 members of the soon- to-be chosen Physician-Focused Payment Model Technical Advisory Committee. They’re to recommend to the Medicare agency new APM models intended to lure docs out of fee-for-service and into new risk-based practice arrangements.