The Medicare Payment Advisory Commission (MedPAC) has suggested ending the Merit-based Incentive Payment System (MIPS), which is one of the payment tracks in MACRA. Nearly all members of MedPAC backed scrapping MIPS at its meeting late last week.
MIPS, which allows providers to earn performance-based payment adjustments to Medicare payments, is too burdensome and won’t improve care, they said.
In place of MIPS, the commission suggested a new program by which a portion of payments (perhaps 2%) is withheld. Providers not in an advanced payment model (APM) could join a group of physicians whose claims data is reviewed on certain population-based health measures to see if they qualify to have the withheld funds returned. Providers who do not participate in an APM or the new model would forfeit the withheld portion.
MedPAC members said MIPS doesn't focus enough on patient care, but instead on whether providers order tests and follow clinical guidelines. MedPAC’s suggestions do carry some influence, but it doesn't create policy. It’s a nonpartisan legislative branch agency that offers analysis and policy advice to the Congress.
Payment adjustments from MACRA are set to begin in 2019, and providers are in the process of choosing their track and making sure they are ready to report their quality metrics. Scrapping the program could bring relief to some providers, but it's late in the game for such a major change.
Providers generally have mixed feelings about MIPS. Most want to push toward value-based payment models, but find flaws in MIPS, particularly the heavy reporting requirements. In response, a recent MACRA proposal would exempt more small providers from the program, leaving about 36% of clinicians eligible for participating next year. In comments to this proposed rule, provider groups suggested tweaks like allowing more advanced alternative payment models to quality for MACRA.
A recent Medical Group Management Association survey found group practices feel MIPS is too complex and doesn't benefit patient care. Nearly three-fourths (73%) of those surveyed said MIPS doesn't “support our practice’s clinical quality priorities” and the same percentage called MIPS either “very” or “extremely” complex. MIPS’ complexity may get worse in 2018.
Michael Abrams, managing partner at Numerof & Associates, recently told Healthcare Dive that he's concerned about the greater flexibility in MIPS in 2018. “MACRA in its original form was extremely flexible, maybe even more flexible than it needed to be or than was actually wise,” said Abrams. “If the point is to minimize the burden on physicians, keep it simple.”
In addition to the complexity, a recent Avalere analysis found that Medicare payments to some specialists could rise or fall by as much as 16% for the 2018 performance year if CMS finalizes its plan to change how MIPS adjustments are calculated.
Some in the industry, however, fear rolling back value-based payment initiatives will be a major setback for the overall movement. AMGA, for example, opposed the increased exemptions to MIPS, saying the move "fails to recognize the significant investments made in preparation for participation" in MACRA.