- Most physicians believe pursuing improvements called for under the Merit-based Incentive Payment System (MIPS) will improve the value of care, a study in Health Affairs finds.
- However, expectations vary depending on factors such as whether compensation is tied to cost and/or quality incentives and whether physicians practice in markets with high versus low Medicare reimbursement and time spent on direct patient care.
- The survey of 684 internal medicine physicians, conducted between March and May 2017, also revealed poor understanding of MIPS requirements and concerns about unintended consequences.
Lack of physician awareness has nagged MIPS from the beginning. In a June 2017 American Medical Association and KPMG survey, fewer than one in four physicians said they were prepared to meet requirements under CMS’ Quality Payment Program, which includes MIPS.
Launched in January 2017, MIPS measures performance in each of four domains — quality, resource use, advancing care information and clinical practice improvement activities — and weights the results to get a composite score. The scores will be used to adjust physician payments by as much as 4% on 2019, growing yearly to 9% in 2022.
The Health Affairs study by researchers at the University of Pennsylvania’s Leonard Davis Institute of Health Economics and the American College of Physicians found that 60% of physicians had little or no knowledge of MIPS. Only 8% reported being very familiar with the policy.
“Our results suggest that policy makers should be mindful of the opportunity to improve MIPS and safeguard it against unintended effects,” the authors write.
There have also been complaints about regulatory burden, particularly on small and solo practices. Small and rural providers have repeatedly maintained that their lack of capital and resources makes complying with the reporting requirements a serious financial strain. Some groups, including the Medicare Payment Advisory Commission, have called for eliminating MIPS, and CMS has acknowledged physicians’ concerns.
In its MACRA/QPP final rule, CMS exempted providers with less than $90,000 in Medicare Part B charges or fewer than 200 Part B beneficiaries and said that clinicians may form virtual groups to participate in MIPS. The virtual groups are restricted to solo practitioners and groups with 10 or fewer eligible clinicians reporting together for a performance period of a year.
But in spite of some leniency, CMS has remained committed to the MIPS model. After agreeing to weight resource use at 0% for the first reporting year, the agency hiked the domain weight to 10% for 2018.
The researchers in this study found strong support for changing behavior to improve value of care based on MIPS focus areas, but less enthusiasm for tying compensation to the resulting performance scores. They also heard calls for increasing the weight for clinical practice improvement activities, set at 15% in 2017 and 2018, and adding domains for patient satisfaction and experience.
Respondents also expressed concerns about “gaming the system” to improve MIPS scores.
For example, 69% said it would encourage doctors to “focus on aspects of care being measured to the detriment of other unmeasured aspects of care,” 60% said doctors would avoid sicker and more medically complex patients to boost quality and performance scores and 56% worried physicians would alter clinical documentation to get a higher MIPS score. More than a third (37%) said the program could cause doctors to “discourage patients from utilizing care in situations when it might be appropriate.”