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Analysis

Expect Big MIPS Changes Under 2019 Quality-Reporting Proposals

By Steven Porter  
   July 16, 2018

The agency's proposed changes to the Quality Payment Program drew a mixed response from industry stakeholders.

Major changes are in store for the Merit-based Inventive Payment System (MIPS) in 2019, as the Trump administration pushes to reduce the recordkeeping burden shouldered by clinicians.

In a slate of proposals released late last week, the Centers for Medicare & Medicaid Services outlined 10 new quality measures it would like to add to the MIPS program, plus dozens it wants to remove. The measures on the chopping block are process-based items clinicians have identified as "low-value or low-priority," CMS said.

The agency also proposed changes to the MIPS "promoting interoperability" performance category. The changes are designed to improve interoperability of electronic health record (EHR) data, give patients easier access to their own health data, and align the performance category with a similar proposal for hospitals.

These proposed changes to the Quality Payment Program are good news, said Gerald Maccioli, MD, MBA, FCCM, chief quality officer for Envision Healthcare.

"As a country, we continue on a positive and productive pathway to figuring out how to use quality measures to markedly improve the health of our communities, and with the proposed changes CMS is moving in the right direction," Maccioli said in a statement.

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"The streamlined measures signify that CMS is listening to clinicians and acknowledging the need to lessen their administrative burden by focusing on the measures that will make the most tangible impact on care delivery and patient outcomes," he added. "Clinicians are the voice from the front lines of patient care so it’s imperative that we involve them in quality improvement initiatives."

Not everyone, however, was pleased with the proposals.

Jerry Penso, MD, MBA, president and CEO of the American Medical Group Association (AMGA) said CMS is continuing to propose policies that "do not further the program's intent and potential." Penso took particular exception to the fact that CMS opted to keep a low-volume threshold that AMGA considers too high.

The group had earlier this month applauded a letter from lawmakers urging CMS to lower the MIPS exclusion threshold to open the program up to more clinicians. About 60% of otherwise-eligible clinicians are excluded from the program due to the threshold, preventing them from earning the payment adjustment authorized by the Medicare Access and CHIP Reauthorization Act (MACRA), AMGA said.

A fact sheet released by CMS notes that 91% of MIPS-eligible clinicians participated in the 2017 performance period, as of May 31.

MAQI Demo Waivers
 

As part of the quality-reporting changes in store for 2019, CMS proposed waiving MIPS requirements for clinicians who participate sufficiently in the Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) demonstration.

Even though some Medicare Advantage plans look a lot like Advanced Alternative Payment Models (APMs), physicians who participate in these innovative MA plans are still subject to MIPS, CMS said. This MAQI demonstration will test whether waiving the MIPS requirement could increase participation in these MA plans and whether it improves patient care.

Blair Childs, senior vice president of public affairs for Premier, commended the move as a positive sign that CMS is looking to loosen some of the regulations that would otherwise dampen APM participation in 2019 and 2020.

"Testing MA participation in APMs through the Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) demonstration is a useful first step, and we support a qualification threshold that would be comparable to other advanced APMs," Childs said in a statement. "We look forward to providing comments to help shape the demonstration."

Steven Porter is editor at HealthLeaders.


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