A Third of Doctors Plan to Do Minimum Under Medicare Pay Program

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By Mindy Yochelson

A third of physicians who expect to participate in the first year of Medicare’s new reporting program plan to do the bare minimum required to avoid a penalty.

A survey of 1,000 practicing physicians who have been involved in practice decision-making about the new quality payment program showed that just a third planned to meet all the reporting requirements.

The Medicare agency gave clinicians the choice of reporting requirements for a full 90 consecutive days and earning the chance for bonuses of up to 10 percent, submitting partial data and earning a slight bonus, or avoiding a penalty by reporting one measure. About 30 percent are going with the last option, according to the American Medical Association and KPMG LLP, an audit company. The two groups surveyed the doctors in the spring.

The clinicians, who were from a variety of practice sizes, practice settings, specialties, and geographic regions, showed gaps in knowledge about the new program that led to concerns about participating.

The Centers for Medicare & Medicaid Services’ quality payment program offers two tracks—participating in the Merit-based Incentive Payment System ( MIPS), which requires reporting quality measures, or participating in an advanced alternative payment model in which doctors are exempt from MIPS.

A majority surveyed (56 percent) expects to participate in MIPS in 2017, while 18 percent plans to join an advanced alternative payment model. Others weren’t planning on participating or weren’t sure.

‘Tremendous Amount of Work’

“There’s a tremendous amount of work that still needs to be done” to educate doctors on how to function under the MIPS reporting program, Carol Vargo, director of Physician Practice Sustainability for the AMA, said June 28. She spoke during a discussion on the survey at a conference on accountable care organizations.

More than four in five respondents (83 percent) believe their practices need more educational opportunities to help them prepare for the quality payment program, S. Lawrence Kocot, principal and national leader for KPMG’s Center for Healthcare Regulatory Insight, told Bloomberg BNA.

Proposal Next Year

The CMS earlier this month proposed rules for the quality payment program in 2018. Of those planning to report through MIPS in 2018, the survey said about two-thirds (65 percent) said they felt prepared to meet requirements. This result “may be related to the yearly process of changes to the physician fee schedule,” the survey said.

The agency said it plans to continue a phased-in approach to participation next year to gradually prepare clinicians for full implementation.

The AMA appreciates another transition year, Vargo said.

“It many be surprising but there’s a lot of physicians out there who are still don’t know how to report just for one patient, one measure,” the minimum for avoiding a penalty in 2017, she said.

She said she plans to discuss the survey results with CMS officials.

More Doctors Exempted

The proposed rule, released June 20, also exempted more doctors in 2018 than in 2017 for not meeting size thresholds for treating Medicare beneficiaries or billing Medicare claims. Many groups applauded this extra leeway for smaller practices.

However, a hospital industry official said she wasn’t happy about the idea of a “two-tier system” that cut off a group of doctors from being part of the quality payment program.

Instead of excluding them, there should be more ways to get them “into the game,” Danielle A. Lloyd, a vice president at Premier Inc., said during the discussion. There could be special scoring and other methods to lower their administrative burden, she suggested.

To contact the reporter on this story: Mindy Yochelson at MYochelson@bna.com

To contact the editor responsible for this story: Brian Broderick at bbroderick@bna.com

Copyright © 2017 The Bureau of National Affairs, Inc. All Rights Reserved.

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