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December 11, 2017

MedPAC unveils draft proposal to replace MIPS

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    The Medicare Payment Advisory Commission (MedPAC) on Thursday released a draft recommendation that calls on Congress to repeal and replace MACRA's Merit-based Incentive Payment System (MIPS), Modern Healthcare reports.

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

    According to Modern Healthcare, MedPAC will vote on the draft recommendation in January. If approved, the commission will include the recommendation in its annual report to Congress, which is issued in March.

    Background: MedPAC considers whether MIPS should be eliminated and replaced

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

    Eligible providers who participate in MIPS in 2017, which CMS deemed a "transition" year for the program, will receive penalties or bonuses of up to 4 percent beginning in 2019. That percentage will increase up to 5% in 2020, and rise incrementally until it reaches 9% in payment year 2022.

    MedPAC members during an October meeting said that MIPS' flexibility makes it overly complex and that the model is unlikely to achieve its intended policy goal of rewarding high-quality care. 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.

    MedPAC earlier this year considered whether to recommend that Congress eliminate or replace MIPS, and nearly all of the commission's members agreed MIPS should be eliminated. However, the members were undecided on whether MIPS should be replaced with a new payment system.

    MedPAC's draft recommendation suggests replacing MIPS

    In the draft recommendation released Thursday, MedPAC calls on Congress to act quickly to eliminate MIPS. Kate Bloniarz, a senior analyst at MedPAC, said, "We believe MIPS is inequitable, burdensome, and will not improve care for beneficiaries."

    MedPAC in the draft recommendation suggested that lawmakers replace MIPS with a voluntary value-based payment program, called the Voluntary Value Program (VVP), under which physicians would be compared with their peers on certain performance-based quality of care measures. CMS would track physicians' performance on the measures based on their Medicare claims, meaning physicians themselves would not have to report on the quality measures.

    Under the new model:

    • Physicians with comparatively higher scores on the measures would receive incentive payments; and
    • Physicians that do not participate in any alternative payment model would have a certain percentage of their Medicare payments withheld.

    According to Modern Healthcare, MedPAC originally had considered withholding 2% of nonparticipating physicians' payments, but were undecided on whether to include that rate in their recommendation.

    MedPAC members remain split on replacement

    Despite releasing the draft recommendation, some MedPAC members remain split over how to best replace MIPS, Modern Healthcare reports.

    Pat Wang, a MedPAC commissioner and CEO of the insurer Healthfirst, said he supports the draft recommendation, but added that the commission still needs to work out "lots of important details" about VVP.

    Similarly, Kathy Buto, a MedPAC commissioner and independent health policy consultant, said, "We say on one hand it's urgent to repeal MIPS, but I don't think we have a good grasp of what's needed in terms of performance measures."

    In addition, one MedPAC commissioner—Alice Coombs, a critical care specialist at the Massachusetts-based South Shore Hospital—said she does not think Congress should scrap MIPS at all. "The climate has changed where physicians are coming to the table and saying what can I do in terms of bettering quality," she said, adding that physicians now are beginning to get accustomed to MIPS. Coombs also expressed concerns that the draft recommendation's proposal to withhold a portion of physicians' Medicare payments could cause some independent medical practices to close (Dickson, Modern Healthcare, 12/7; Frieden, MedPage Today/HealthLeaders Media, 12/8; Williams, CQ HealthBeat, 12/7 [subscription required]).

    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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