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October 25, 2017

CMS to launch pilot test to track Medicare spending under MIPS

Daily Briefing

    CMS said it will launch a pilot test to determine if physicians participating in its Merit-based Incentive Payment System (MIPS) are actually lowering their cost of care, Virgil Dickson writes for Modern Healthcare.

    Access the 2017 Merit-Based Incentive Payment System (MIPS) score estimator


    Under MACRA's Quality Payment Program (QPP), which took effect in 2017, eligible professionals can choose from two payment tracks: 

    • The Advanced Alternative Payment Model (APM) track, for clinicians who take on a significant portfolio of Advanced APMs, which include risk-based accountable care organization models; or
    • The MIPS track, for providers who are reimbursed largely through fee-for-service.

    Eligible providers who participate in MIPS for the 2017 reporting year will receive penalties or bonuses of up to 4 percent beginning in 2019. That percentage will rise incrementally until it reaches 9 percent in payment year 2022. Participating providers must submit all data to CMS by March 31, 2018.

    Details on pilot test

    According to Dickson, the pilot test will assess cost data for eight conditions and procedures to determine if doctors participating in MIPS are reducing costs, including:

    • Cataract removal;
    • Colonoscopy;
    • Intracranial hemorrhage;
    • Knee arthroplasty;
    • Lower limb revascularization;
    • Percutaneous coronary intervention; and
    • Pneumonia.

    As part of the pilot, CMS has used claims data from June 1, 2016 to May 31, 2017 to generate reports for about 17,000 medical practices. Physician groups have been invited to review the reports for accuracy, and provide their comments, which will be used to refine the pilot's selected measures before they are incorporated in MIPS. Providers may submit comments until November 15.

    Increasing concern among providers

    According to Dickson, CMS' latest announcement comes about two weeks after the Medicare Payment Advisory Commission (MedPAC) during a meeting suggested that MIPS' flexibility makes it overly complex and is unlikely to achieve its intended policy goal of rewarding high-quality care.

    During the meeting, MedPAC members also critiqued the degree to which MIPS allows clinicians to decide which measures they will be evaluated on, likely leading clinicians to pick metrics for which they are high-performers, and focuses on process measures, rather than patient outcomes measures.

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    Kate Goodrich, CMO for CMS' Center for Standards and Quality, acknowledged that some providers have voiced concerns about how they will be evaluated under MACRA, given that CMS has proposed a rule delaying compliance for the second year in a row, but that there is an underlying understanding that the correct measurements should be developed first.

    But according to Dickson, providers are also concerned that the measures by which CMS will evaluate them in this test might not be adequate. Anders Gilberg, SVP of government affairs at MGMA, said "We have concerns about the complexity of the algorithms developed for the measures and how CMS will translate these cost measurements into a MIPS score given that these eight measures will not apply across the board to all [clinicians]" (Dickson, Modern Healthcare, 10/19). 

    5 things everyone should know about MACRA

    The implementation of MACRA is the most notable change to Medicare physician payment in over a decade. Passed with bipartisan support, MACRA changes the way Medicare pays clinicians.

    Check out our infographic to see the no-regrets strategies to prepare your organization for success under MACRA.

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