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.
IPAB on the ropes
Meanwhile, on another front, the House Ways and Means Committee voted Oct. 4 to repeal the controversial Independent Payment Advisory Board (IPAB), which was created by the Affordable Care Act and slammed as a “death panel” by Republicans. The purpose of the IPAB, which has never been implemented, is to provide the administration and Congress with cost-cutting recommendations if Medicare spending reaches a certain threshold. The IPAB has been strongly opposed by major urology organizations.
Approval of the repeal legislation by the Ways and Means Committee is an important first step, especially since the measure is backed by 43 Democratic co-sponsors. It still must be passed by the full House and Senate before going to President Trump, who insiders believe will gladly sign it.
“While the repeal of IPAB will not have any practical effect on how urologists in independent practice approach treatment, it will restore accountability for spending on Medicare to elected officials,” said Neal D. Shore, MD, president of LUGPA.
Also by Bob Gatty: AUA’s USPSTF reform efforts continue
“We look forward to continuing our dialogue with lawmakers to ensure Americans have access to appropriate Medicare coverage under legislation that promotes quality care with fair reimbursement for physicians,” Dr. Shore told Urology Times. “LUGPA strongly supports repealing IPAB, as this unelected board has the power to initiate cuts to Medicare without congressional consent and thus compromise patient access to care.”
DoD research funding in jeopardy
A third issue important to urologists has been moving in Congress, this one involving funding for critical medical research programs at the Department of Defense.
The AUA has been working in support of an amendment to the National Defense Authorization Act (NDAA) for fiscal year 2018 that would nullify provisions in that bill narrowly defining how research funding can be used.
“Undoubtedly, this language would impact existing funding for prostate, kidney, and bladder cancers and other painful urologic disorders such as interstitial cystitis,” the AUA said in a “Policy and Advocacy Brief” on its website. “If enacted, it could jeopardize funding for urologic research activities that have broader relevance to the U.S. military, including the health and well-being of military families and veterans, and the efficiency of the military health care system.”
The amendment to remove the restrictive language was sponsored by Sen. Dick Durbin (D-IL).
“At a time in America when we need medical research—for breast cancer, for brain disease, Alzheimer’s—for all of the things that are facing us, why would we cut back on medical research?” Durbin asked. “It’s a serious mistake.”
“It is absolutely critical that we maintain funding for research into causes, treatments, and therapies for diseases that affect those who serve on the battlefield, their spouses, and dependents,” said Sen. Lisa Murkowski (R-AK), a co-sponsor of the Durbin amendment. “Medical research in the Defense Department is another way we demonstrate to those who place their lives on the line that the American people have their back.”
However, the Senate approved the NDAA, including its restrictive language, despite the objection of the AUA and more than 140 medical research associations and many veterans groups. The NDAA version approved by the House did not include those restrictions, and at press time, a House-Senate conference was expected to iron out that and other differences between the two measures.
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