An advisory committee says the government should redesign the Merit-based Incentive Payment System (MIPS) if it wants the new payment method for doctors to improve outcomes and reduce costs.
The Medicare Payment Advisory Commission (MedPAC) made recommendations for changes to MIPS, one of two tracks under the Medicare Access and CHIP Reauthorization Act (MACRA), in its June report to Congress. The commission, which advises Congress on Medicare payment issues, devoted a chapter of its report to ways to improve MIPS by incorporating more patient outcomes and reducing the reporting burden on physicians. It also made recommendations to strengthen advanced alternative payment models.
“MIPS as presently designed is unlikely to help beneficiaries choose clinicians, help clinicians change practice patterns to improve value or help the Medicare program reward clinicians based on value,” the commission wrote.
MedPAC said the measures used in MIPS will not distinguish between high- and low-performing practices, and that small differences in quality scores could produce a wide disparity in payment bonuses. The commission proposes eliminating the current set of MIPS measures and instead relying on population-based outcome measures, such as preventing hospital admissions or patient experience. The proposed outcome measures would be calculated from claims or surveys and therefore would not require burdensome clinician reporting, the report said.
Under the current design, MIPS evaluates doctors on quality, cost, practice improvement and use of electronic health records. MedPAC worries that individual physicians typically have so few patients who qualify for each measure that it may not be possible to evaluate real differences in performance.
While physicians are now in the first year of MACRA, a recent survey found that among doctors in decision-making roles, fewer than 1 in 4 say they are well prepared to meet quality reporting requirements under the program. The survey also found that 90% of the doctors described MIPS as burdensome.
The Centers for Medicare & Medicaid Services is trying to address some of those concerns in a final rule released last month that eases some of the reporting requirements under MACRA for smaller practices.