If members of the Medicare Payment Advisory Commission (MedPAC) have their way, the new Merit-based Incentive Payment System (MIPS) will be sent into oblivion, never to be heard of again.
During a meeting in Washington Oct. 5, MedPAC members, who include physicians, health care executives, and other policy experts, essentially said MIPS should be trashed as commission analysts offered the framework of a possible alternative.
MIPS is one of two payment systems established by the Medicare Access and CHIP Reauthorization Act. The second consists of Advanced Alternative Payment Models (APMs), which major urology organizations have been working to develop.
Within MIPS, physician pay depends on performance in four categories: Quality, Cost, Improvement Activities, and Advancing Care Information.
According to critics at MedPAC, the MIPS program is overly complex because of the various reporting options and exemptions. Ultimately, Medicare gives clinicians a score based on performance and either increases or reduces their payment based on that score.
“It is extremely unlikely that physicians will understand their score or what they need to do to improve it,” said David Glass, MedPAC principal policy analyst.
An alternative approach suggested by Glass and MedPAC senior analyst Kate Bloniarz, which they called the Voluntary Value Program, would withhold a small percentage of clinicians’ fee schedule dollars to be placed in a pool to be used for value payments for those in a “sufficiently large entity,” such as those affiliated with a single hospital or one geographic area. Other physicians could choose to participate in an Advanced APM.
The sentiment to kill MIPS was part of a discussion at the Oct. 5 meeting; it remains to be seen if a formal recommendation to that effect is presented to Congress, and then, of course, it is up to lawmakers to determine if that recommendation is to be enacted.