The lone holdout on ditching the program noted that eliminating MIPS and replacing it with the Voluntary Value Program (VVP) could cause more physicians to rush to become hospital employees.
This article first appeared December 08, 2017 on Medpage Today.
By Joyce Frieden
WASHINGTON -- Momentum appeared to be growing on Thursday for a proposal from the Medicare Payment Advisory Commission (MedPAC) to get rid of the Merit-Based Incentive Payment System (MIPS) for reimbursing physicians who see Medicare patients.
"We need to act on this now," MedPAC staff member Kate Bloniarz told the commissioners. She added that clinicians will start reporting their quality data this year for reimbursement in 2019. "The longer the payments go out, the more there will be an established [group] of clinicians receiving really high payment adjustments who will resist changes to the program."
MIPS, which was enacted as part of the Medicare Access and CHIP Reauthorization Act (MACRA), combines parts of the Physician Quality Reporting System (PQRS), the Value-based Payment Modifier, and Meaningful Use into one single program based on quality, resource use, and clinical practice improvement. Under MIPS, doctors earn a payment adjustment based on evidence-based and practice-specific quality data that they report to the Centers for Medicare & Medicaid Services (CMS).
Bloniarz listed a number of concerns with MIPS, including:
- It gives physicians a heavy reporting burden, which was estimated at more than $1 billion for the first year of the program
- Much of the information reported isn't meaningful, partly due to small sample sizes and the fact that only a few quality measures assess meaningful outcomes, she said. In addition, each clinician is scored on different measures representing different levels of effort, "so it's not comparable across clinicians, but CMS will move substantial funds around each year based on these non-comparable scores"
- CMS has exempted more clinicians from MIPS in 2018 than are required to participate, and has special rules for small and rural clinicians. As a result of these and other CMS actions, in years 3 and later, "small differences in [scores] will be blown up into potentially massive differences in payment adjustments. The system is inequitable ... It won't move clinicians and the Medicare program toward high-value care"