Why MedPac is calling for the replacement of MIPS


If you’re having trouble keeping up with what’s happening in health care reform, you’re not alone. Among recent efforts of interest to post-acute and long-term care practitioners, the Medicare Payment Advisory Commission (MedPAC) is urging the immediate repeal and replacement of the Merit-based Incentive Payment Systems (MIPS). According to MedPAC, MIPS places a burden on physicians without any guarantee or proof that it will improve care.

This move shouldn’t be surprising coming from an administration that early on focused on reduced regulatory oversight and costs—for health care and other industries. At the end of January, in fact, President Trump issued an executive order (EO) aimed at reducing and controlling regulatory costs. Specifically, it said, “For every one new regulation issued, at least two prior regulations must be identified for elimination, and that the cost of planned regulations be prudently managed and controlled through a budgeting process.” Nonetheless, to date none of the President’s EOs have addressed or are expected to affect MIPS’ implementation. In fact, CMS is currently field testing several MIPS episodes.

While MedPAC doesn’t have the authority to create policy, it does carry influence with both Congress and the Centers for Medicare and Medicaid Services (CMS). So while I wouldn’t throw a MIPS farewell party yet, the program is likely to come under scrutiny in the coming months. MedPAC commissioners ware nearly unanimous in their agreement that MIPS should be repealed.

Why has MedPAC targeted MIPS? The initiative was designed as a pay-for-performance initiative that pays physicians on four categories: quality, resource use, clinical practice improvement, and advancing care information via health information technology (i.e., meaningful use). While CMS estimates that over 400,000 physicians will be submitting MIPS data for this year, MedPAC says the program is seriously flawed.

One concern—which is shared by many practitioners and providers—is that the quality measures focus on how physicians perform instead of whether or not the actions ultimately improved care/outcomes.

Another flaw, according to MedPAC, is that MIPS lets clinicians choose the measures for which they will be evaluated; there currently isn’t anything in place to discourage them from choosing measures on which they tend to perform well. At the same time, several MIPS categories rely on self-reporting; and there are concerns that this could negatively impact the validity of results.

Finally, MedPAC just doesn’t think that MIPS is cost-efficient. CMS estimates that providers will spend over $1 billion to report and track MIPS measures this year alone. Yet there is no data to suggest that the savings will exceed the expenditures or even come close. It is worth noting that this isn’t the first time that MedPAC has targeted MIPS. In its June report to Congress, the commission included a detailed proposal to simplify MIPS reporting to reduce the burden on physicians.

If MIPS is scrapped, then what? All Medicare physicians not in an alternative payment model (APM) such such as an Accountable Care Organization would have 2% of their payments withheld. After the money is withheld, providers would have two options:

  1. To get the money back, those not in an APM could join a group of clinicians and become part of a new voluntary pay model where they would be evaluated on performance-based measures, such a mortality rates.
  2. The other option is to stay in fee-for-service mode and lose out on the 2% withheld reimbursement.

Organizations representing the PA/LTC industry are monitoring this issue and may issue comments on MIPS and advanced payment in the months ahead.  Organizations such as the American Health Care Association and AMDA—The Society for Post-Acute and Long-Term Care Medicine likely will be coordination on MIPS-related issues.