In its June 2017 report to Congress, the Medicare Payment Advisory Commission (MedPAC) advised that the Merit-based Incentive Payment System (MIPS) under MACRA be redesigned.
MedPAC, a Congressional agency that provides policy and technical advice to Congress on issue, delivers a report each June on Medicare and broader healthcare issues. This year, it said that MIPS, as presently designed, “is unlikely to help beneficiaries choose clinicians, help clinicians change practice patterns to improve value, or help the Medicare program reward clinicians based on value.”
MIPS is one of two payment tracks that eligible Medicare clinicians who are participating in MACRA (the Medicare Access and CHIP Reauthorization Act) can take part in. The other is the advanced alternative payment model (A-APM) track. According to the MedPAC report, “To address these challenges, the Commission discusses an alternative construct for MIPS in which Medicare would withhold a portion of payments from clinicians. Clinicians could get back this withhold through performance on quality metrics or by participating in an A–APM. The current set of MIPS quality measures could be eliminated and replaced with a smaller set of population-based outcome measures.” The report further noted, “The proposed outcome measures would be calculated from claims or surveys, and thus would not require burdensome clinician reporting.”
What’s more, MACRA creates a fund of $500 million per year for MIPS (from 2019 to 2024) to reward clinicians with “exceptional performance” on their MIPS scores. The report, however, suggested moving this fund from MIPS to A–APMs, “which would shift clinician incentives toward A–APMs by making MIPS less attractive.”
Further, MedPAC noted that MACRA includes a 5 percent incentive payment for clinicians who have a sufficient amount of their fee-for-service revenues coming through A–APM entities. Currently, clinicians must reach a threshold of revenue through an A–APM (e.g., 25 percent, 50 percent) to be eligible for the 5 percent incentive payment, but the incentive payment is then applied to all of their physician fee schedule revenue—whether or not it comes through the A–APM.
The report, however, suggested making the reward related solely to the revenue coming through an A–APM. It said, “There would be no threshold; instead, the incentive payment would be proportional to A–APM involvement: Any physician fee schedule payment coming through an A–APM would get the 5 percent incentive payment added to it. This design would create greater certainty of payment, be more equitable, and would create an incentive for clinicians to move their services to A–APMs,” according to MedPAC.
In its report, MedPAC also touched on other noteworthy issues, such as implementing a unified payment system for post-acute care, as well as showing support for the medical device industry.
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