Groups like the Medicare Payment Advisory Commission have had harsh criticism for MIPS, but a number of challenges stand in the way of moving forward with an alternative.
The MedPAC has instead suggested that Congress scrap the Merit-Based Incentive Payment System program entirely and replace it with a different model. But while there are legitimate concerns about MIPS and how it will operate, simply eliminating it in favor of an untested alternative is not necessarily the right answer, wrote Gail R. Wilensky, Ph.D., an economist and senior fellow at Project HOPE, in an article for the New England Journal of Medicine.
Wilensky, who also oversaw Medicare and Medicaid in the first Bush administration and has chaired MedPAC, wrote that the ideological divide in Congress, in tandem with a very slim Republican majority in the Senate, makes congressional action on MIPS unlikely in 2018.
Plus, MedPAC's alternative, which they called a "Voluntary Value Program," does not have the backing of most medical groups, Wilensky wrote. Instead, many medical associations and the American Hospital Association would like to see MIPS adjusted to better meet physicians' needs without eliminating the program.
In MedPAC's model, 2% of physicians' fee-for-service payments would be withheld, and to get it back, doctors would have to enroll in an advanced alternative payment model. Wilensky wrote that the first step, if policymakers are serious about ditching MIPS, would be for the Centers for Medicare & Medicaid Services' innovation center to test MedPAC's model as soon as possible.
A pilot program would determine whether the proposed strategy is better than MIPS in terms of helping clinicians improve their practice and helping beneficiaries identify the healthcare organizations that offer better outcomes for their needs, she said. In tandem, the Center for Medicare & Medicaid Innovation could test other alternatives proposed by groups like the American Academy of Family Physicians.
In lieu of starting over completely, stakeholders can take steps to make MIPS work a bit better for clinicians, Wilensky wrote. Physicians can be afforded more time to adjust without penalty, and CMS can work with payers, beneficiaries and providers to devise a concise list of quality measures to ease the reporting burden.
And physicians need to speak up about MIPS, and what they think works and what doesn't, Wilensky says. Physicians are "woefully bad at making their voices heard," and this is an opportunity for them to lead the charge on beneficial change, she wrote.
The Trump administration has taken aim at the reporting and administrative burdens physicians face. The White House's 2019 budget proposal would eliminate quality reporting under MIPS entirely, leaving physicians more time to focus on patient care.