CMS proposed a Medicare Advantage demonstration that would allow clinicians to sidestep Merit-Based Incentive Payment System (MIPS) requirements for those who participate “sufficiently” in certain risk-based MA plans.
The Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) would offer another choice to providers, who have said there aren’t enough alternative payment method (APM) options to avoid MIPS requirements.
The agency is seeking public comment on the proposal and asking providers about potential burdens connected to the demonstration.
The CMS said MA plans create arrangements that are similar to Advanced APMs, but clinicians still face MIPS “even if they participate extensively in Advanced APM-like arrangements under Medicare Advantage.” The demonstration will test another alternative.
CMS Administrator Seema Verma said the demo is part of the agency’s goal to move from a fee-for-service to value-based healthcare system. Verma added it “aims to put Medicare Advantage on a more equal playing field with fee-for-service Medicare.”
“CMS intends to test whether MIPS exemptions provided to clinicians under MAQI will increase participation in Medicare Advantage plans that are similar to Advanced APMs, and thereby accelerate the transition to a healthcare system that pays for value and outcomes,” Verma said in a statement.
At least one doctors' group expressed support for the concept.
Donald Crane, president and CEO of America’s Physician Groups, in a statement said the pilot would create “an important new path for groups wishing to move into value.”
“With nearly 19 million beneficiaries enrolled in Medicare Advantage, it is important to recognize the innovations that physician organizations are undertaking to provide high-quality accountable care to the patients and communities they serve. Advancing the MAQI demonstration is an important step in the right direction,” he added.
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) provides two fee-for-service payment tracks: MIPS, which bases payments on physician-reported quality data, and Advanced APMs, which requires providers to take on risk for patients’ healthcare spending.
The Medicare Payment Advisory Commission (MedPAC), which advises Congress, recommended a complete repeal of MIPS last year. MedPAC suggested a program instead that withholds a portion of payments to create a rewards pool.
Providers have complained about the administrative burden associated with MIPS. Most physicians surveyed by the American College of Physicians said MIPS measures fail to adequately capture the quality of care they provide patients.
However, despite those concerns, most healthcare groups don’t want a total repeal of MIPS. For instance, the American Hospital Association suggested MedPAC “use data and experience from the field before advocating for major changes to the MIPS.”