Credit: Matthew Bisanz.
The Medicare Payment Advisory Commission, which advises Congress on Medicare policy, has come out strongly against the merit-based incentive system for physician payment and bonuses.
MedPAC wants Congress to get rid of MIPS and its reporting requirements now before the Centers for Medicare and Medicaid Services starts making payment adjustments under the program in 2019.
Commissioners, many of them physicians, instead want to see the creation of a voluntary value program that would have CMS assessing performance using a set of population-based measures comparable to those in the advanced alternative payment model of the Medicare Access and CHIP Reauthorization Act.
MedPAC said in Thursday's meeting that its recommendations follow its June report to Congress.
Under its recommended option, physicians would have a portion of the fee scheduled payments withheld, such as 2 percent.
Clinicians could elect to be measured with other clinicians in a sufficiently large entity to be eligible for value payment, join an APM, or do nothing and lose the withheld amount, according to the October 5 report by MedPAC policy analysts Kate Bloniarz and David Glass.
Entities would be collectively measured on population-based measures that assess clinical quality, patient experience and value, in an assessment similar to APMs.
Clinical measures would include avoidable admissions, ER visits and readmissions. Patient experience would include the ability to receive care and communicate concerns, and value would be based on factors such as spending per beneficiary after a hospitalization.
MIPS puts a significant burden on clinicians and is too complex, according to MedPAC. CMS estimated over $1 billion in the reporting burden in 2017, commissioners said.
CMS's emphasis on flexibility and options has only increased the complexity, MedPAC said.
MIPS measures have not been proven to be associated with high-value care, and many physicians will not understand what they need to do to improve their score, since they're already performing at a high level. The current system is structured to maximize clinician scores, with a limited ability to detect performance, the MedPAC report said.
From 2019 to 2020, the high scores combined with low performance standard will result in a minimal reward. In later years, minimal differences will result in big payment swings.
MedPAC said its new approach limits bonuses but reduces the burden.
MIPS adjusts Medicare fee-for-service clinician payment based on performance, building on former measures for quality and the electronic health record incentive program.
It applies to physicians who are above a low-volume threshold.
The first year of MIPS adjustment is 2019, with physicians reporting now. Quality, based on six measures, makes up 60 percent of the score, with meaningful EHR use accounting for 25 percent.