The CMS will test whether MACRA and physicians in the Merit-based Incentive Payment System (MIPS) can reduce Medicare spending, Modern Healthcare reports.
The pilot test will analyze costs associated with eight procedures and medical conditions: percutaneous coronary intervention, knee arthroplasty, cataract removal, lower limb revascularization, colonoscopy, intracranial hemorrhage and pneumonia.
The CMS will review claims data from June 2016 to May 2017 for about 17,000 medical practices.
The announcement of CMS’ pilot test comes only weeks after the Medicare Payment Advisory Commission (MedPAC) recommended the repeal of MIPS, which is one of the payment tracks in MACRA. MIPS allows providers to earn performance-based payment adjustments to Medicare payments, but MedPAC members said it’s too burdensome and won’t improve care.
MedPAC instead suggested a program that would withhold a portion of payments, such as 2%. Providers not in an advanced payment model could join other physicians. The CMS would review their claims data on population-based health measures and then decide whether to provide the withheld funds.
Now, after MedPAC’s recommendation, the CMS is looking to test whether MIPS could successfully reduce healthcare costs. The review will test a common question in healthcare: Is valued-based care making a difference?
Reports on value-based care have been a mixed bag. Holly Martin, senior manager at Top Tier Consulting, recently told Healthcare Dive that CMS sees reduced payments in value-based care, but the “actual dollar amounts that are being saved are not huge compared to the healthcare spend overall.”
“Part of the challenge is people are changing and innovating and seeing results in quality and cost, and Medicare is seeing some reduced payments, but the accumulated learning experience is hard to consolidate nationally,” Martin said.
There’s also the issue that many physicians aren't ready for MACRA. A recent study by the American Medical Association and KPMG found that fewer than one in four physicians feel prepared to meet the requirements.
In a different study, Medical Group Management Association reported that group practices believe MIPS is too complex and burdensome. Of the practices surveyed, 73% said MIPS “does not support our practice’s clinical quality priorities.”
Greg Carey, senior government and regulatory affairs manager at athenahealth, recently told Healthcare Dive that MACRA’s complexity “undercuts the potential for better care and lower costs.” Plus, there’s concern that clinicians may not have access to CMS cost and quality data even though that's how the CMS will judge physicians. If they're not able to review that information, physicians worry they won't know how to improve those measures.