While the new Medicare payment system for physicians has flaws that need to be fixed, doctors were unanimous about one thing: They don’t want to see it scrapped.
All five doctors testifying today before the House Energy and Commerce Health Subcommittee said it would be better to continue to implement the Merit-based Incentive Payment System (MIPS) than see it replaced.
They also agreed that the new payment system in place today is much better than the old sustainable growth rate formula. “It’s a rare opportunity for five doctors to agree,” said Kurt Ransohoff, M.D., chairman of the board of America’s Physicians Group, who was invited to the panel to provide lawmakers with an update on MACRA and MIPS.
“MIPS should be fixed. It shouldn’t be discarded,” he said.
The doctors said they disagreed with a vote by the Medicare Payment Advisory Commission (MedPAC) in January to replace MIPS, which is now in its second year. The doctors said they prefer to work to fix the payment system they have now.
The doctors offered lawmakers some fixes, including the following:
Create better measures that are relevant to patient care. “It’s time we measure what matters,” said Frank Opelka, M.D., medical director of quality and health policy at the American College of Surgeons. For instance, most MIPS measures do not measure surgical care, he said. It makes no sense for a breast cancer surgeon to report on the rates of patients’ tobacco cessation.
Create alternative payment models (APMs) that specialists can participate in. APMs are the second payment track created by MACRA. Parag Parekh, M.D., chairman of the government relations committee of the American Society of Cataract and Refractive Surgery, said existing APMs are designed for primary care, leaving ophthalmologists such as himself excluded from that payment option.
Include more physicians in MIPS. The Centers for Medicare & Medicaid Services (CMS) should lower the thresholds by which physicians do not have to participate in the payment system. In a proposed rule released this month that outlined changes for year three of the payment program, CMS said it would keep the 2018 threshold in place for 2019 but will allow doctors in small practices who don’t meet the thresholds to opt into MIPS. That would allow them to be eligible for bonus incentives. Ransohoff said that still excludes too many doctors from moving into value-based care and suggested CMS should create a MIPS program designed for smaller groups instead of excluding them entirely. “You have a bunch of people who are believers,” he said about the move to value-based care, but another group that does not want to change.
It has been said that MIPS is an entry ramp for physicians who want to move to value-based care, said Ashok Rai, M.D., chairman of the board of the American Medical Group Association. “CMS has created an exit ramp,” he said.
Approve more APMs, including those recommended by the Physician-Focused Payment Technical Advisory Committee (PTAC), the group set up under MACRA to evaluate new payment models submitted by physician groups. PTAC had positive recommendation on 10 models, but none have been approved for testing or implementation by HHS, said David Barbe, M.D., immediate past president of the American Medical Association. CMS seems to be more interested in coming up with its own ideas, he said.
Make changes to the Stark law. The Stark law, which prohibits physicians from referring patients to other providers with whom they have a financial relationship, is standing in the way of the move to value-based care and alternative payment models, the doctors said. CMS has issued a request for information seeking recommendations and public input on how to reduce the burden of the federal anti-kickback law.
Lawmakers appreciated the feedback from doctors on how to improve the payment system put in place under MACRA, said Rep. Michael C. Burgess, M.D., R-Texas, who chairs the health subcommittee.
“It is important that we get it right,” he said.