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MedPAC recommends eliminating MIPS

By Grant Huang
Director of Content at DoctorsManagement

A top Congressional advisory body has voted to recommend that Congress repeal the Merit-based Incentive Payment System (MIPS) and replace it with a simpler version that would not be mandatory like MIPS is for most providers who participate with Medicare.

The Medicare Payment Advisory Committee (MedPAC), an independent federal board whose mission is to advise Congress on the management of the Medicare program, voted 14-2 to make the recommendation. MedPAC, which was created in 1997, has no actual legislative power, but issues regular annual reports with recommendations to Congress on improving Medicare, which Congress can choose to act on (or not). In the past MedPAC has repeatedly recommended eliminating the Sustainable Growth Rate (SGR) formula and implementing delivery system reforms that would shift the industry from fee-for-service to pay-for-performance.

The MedPAC vote was criticized by some provider stakeholder groups on the grounds that, with MIPS well underway, many providers had invested significant time and resources into participation, and that MedPAC’s alternative proposal would not be consistent with Congress’ legislative intention when it passed the law that created MIPS.

Anders Gilberg, vice president of government affairs for the Medical Group Management Association (MGMA), issued a statement opposing the move by MedPAC. While the MGMA acknowledges that MIPS can be “unduly burdensome,” Anders said in a statement, the group also believes that MedPAC’s vote asking Congress to repeal the program “fails to adequately address the problem and does not reflect the current value-based landscape.”

The American Medical Association (AMA) also objected to MedPAC’s Jan. 11 vote, arguing instead for reforms and changes to be made to MIPS as part of CMS’ ongoing Quality Payment Program (QPP) rulemaking process.

MIPS is a key cog of the Medicare Access and CHIP Reauthorization Act (MACRA) that was passed with bipartisan support in 2015. While providers have complained about its reporting requirements, the lop-sided impact of its administrative burdens on small groups, and the rapid implementation time-table, most of the industry has focused on MIPS preparation and gradual reform of the program via QPP rulemaking.

MedPAC offers a ‘redesigned’ version of MIPS

Prior to the vote on recommending MIPS repeal, MedPAC published a June 2017 report in which it offered an alternative version of MIPS. This alternative, which MedPAC refers to as “a potential redesign of MIPS,” would work by withholding a portion of all Medicare fee-for-service payments annually to fund a quality pool.

Medicare providers could then choose from one of the following actions:

Do nothing and lose the withheld money.

Join or form an Advanced Alternative Payment Model (A-APM) entity, after which they would receive the withheld money.

Join a group of clinicians for performance measurement by CMS and receive the withheld money, with a potential additional quality payment based on performance.

Join a CMS-defined group treating a CMS-defined local population for measurement and receive the withheld money, with a potential additional quality payment based on performance.

For the purposes of option #3 and #4, CMS would be doing all of the performance measurement via analysis of claims data and patient surveys, so no reporting actions would be required of any participating practices or providers (beyond simply submitting their decision to join either group), MedPAC states.

“Under this framework, clinicians could not be worse off by choosing to be measured as a group or local area member than if they made no election at all, that is, they could not lose more than their withhold,” MedPAC writes in the report. “The concept is to adopt a broader, claims- and survey-calculated uniform measure set that assesses the overall performance of a health care delivery system and its clinicians.”

MedPAC believes that MIPS, as currently constituted, “will not identify or appropriately reward high- and low-value clinicians” while simultaneously requiring “a massive reporting effort.” Measuring large groups of clinicians on population-based outcomes would produce a more accurate picture, and is the design goal of MedPAC’s proposed alternative.

MedPAC can only recommend; Congress doesn’t have to listen

An actual repeal of MIPS would require another act of Congress and support from the Trump administration. Seema Verma, the new CMS administrator appointed by President Trump, has voiced support for MIPS and pledged to simplify the reporting process while reducing its impact on smaller practices. It’s not clear whether the MedPAC proposal will gain any momentum in Congress or support from the Trump White House.

Author: Grant Huang (ghuang@drsmgmt.com)