MedPAC Urges Congress to Axe MIPS

John Commins, March 15, 2018

The commission wants Congress to adopt a Voluntary Value Program that eases the administrative burden on clinicians, and provides a more objective assessment of the value of care delivered based on population health metrics.

The Medicare Payment Advisory Commission (MedPAC) on Thursday issued its massive, semiannual report to Congress, with a recommendation that lawmakers end the Merit-based Incentive Payment System (MIPS).

In its place, MedPAC recommends establishing a Voluntary Value Program that it says would be less taxing on physicians, and which would more objectively assess the value of the care provided by using broader population health metrics.

The recommendations in the 563-page report follow the commission’s vote at its January meeting to eliminate MIPS. Congress is free to either take up the recommendations or ignore them.

"We came to this determination based on a two-year analytic work in which we started out examining ways in which MIPS might be improved," MedPAC Executive Director James Mathews said in a media conference call on Thursday.

"Over the course of two years we came to the conclusion that there were certain fundamental flaws in the premise of MIPs that suggest could not be improved," he said.


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Mathews cited a number of flaws in MIPS, which he said makes the program "inequitable among physicians."

"Physicians get to choose their own measures under MIPS and the incentive is going to be for each physician to choose measures upon which they will likely succeed and perform well," he said.

He said MIPS also imposes a significant time and money burden on clinicians.

"CMS estimated a compliance cost of $1.3 billion in first year and costs of well over $500 million in years going forward," Mathews said. "We believe these expenditures will not result in a meaningful assessment of clinicians' performance such that it provides the basis for Medicare to move dollars around under MIPS."

Mathews called MedPAC's proposed replacement for MIPS—the VVP—a more streamlined approach that leaves the heavy lifting of data compilation to Medicare.

John Commins

John Commins is a senior editor at HealthLeaders Media.

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