Why MedPAC wants to scrap MIPS

MedPAC recommended the government replace MIPS because it is costly to physician practices and won’t lead to higher quality care, says the man who served as the commission’s director for 15 years.

The Medicare Payment Advisory Commission (MedPAC) suggested to Congress that it replace the Merit-Based Incentive Payment System Program (MIPS) because the Medicare payment system for physicians is flawed, Mark E. Miller, Ph.D., said in an interview with NEJM Catalyst.

In fact, the Centers for Medicare & Medicaid Services has estimated that the MIPS data collection process costs practices about $1 billion, said Miller, who recently left after 15 years as the commission’s executive director to become vice president of healthcare for the Laura and John Arnold Foundation. MedPAC also thinks that the data physicians collect is not going to lead to higher quality care, he told the publication.

RELATED: MedPAC votes to replace MIPS, but physician groups not ready to abandon new payment system

MedPAC voted 14-2 last month to recommend that Congress scrap MIPS and replace it with an alternative model. However, as much as they dislike aspects of MIPs, two major physician groups both disagreed that MIPS, a payment system that’s been in place for just over a year, should be replaced. Instead, the American Medical Association and the Medical Group Management Association want to work to fix the existing program.

But Miller said MIPS is not moving payment in the right direction, away from fee-for-service. “What we’re trying to do is try to reduce the burden, make it simpler for the physician and then also arrange the quality measures to be more oriented to population measures rather than individual physician and process measures,” he said in the NEJM Catalyst interview.

However, the proposal from MedPAC would require action by Congress and changes by CMS, Miller said.

In the meantime, the budget deal reached late last week, ending a second federal government shutdown of 2018, will allow changes to MIPS.

The legislation signed into law by President Donald Trump Friday morning will add flexibility to the cost component of MIPS. The cost component will make up 10% of a clinician’s MIPS score this year and was slated to increase to 30% next year. The legislation will allow CMS to keep the cost component at the 10% level through 2021 and prevents the agency from pushing it any higher than 30% in subsequent years.

In a Twitter post, Anders Gilberg, senior vice president of government affairs for the MGMA, said the legislation “is largely a win for physician practices,” including reducing the MIPS burden.

In a letter (PDF) to Congressional leaders, the AMA also expressed support for the legislation, including making technical improvements in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) to promote a smooth transition to the new Quality Payment Program that includes MIPS.