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

As much as they dislike aspects of MIPS, two major physician groups disagree with a vote by the Medicare Payment Advisory Commission yesterday to replace the Medicare payment system that’s been in place for just over a year.

Both the Medical Group Management Association and the American Medical Association said they are not ready to abandon the Merit-based Incentive Payment System, the program track under the Medicare Access and CHIP Reauthorization Act (MACRA) that covers most physicians. The groups prefer to fix what they have.

MedPAC voted 14-2 in favor of recommending to Congress that it kill MIPS and replace it with an alternative model, called the Voluntary Value Program. But MGMA labeled that model a “poor replacement.” 

In a presentation to MedPAC members, staff said MIPS cannot succeed as designed for numerous reasons including that it replicates flaws of previous value-based programs, is “burdensome and complex” and that much of the reported information is not meaningful.

Instead, MedPAC is in favor of replacing MIPS with a voluntary program in which clinicians can elect to join a group or an advanced alternative payment model. Those who join a group will be assessed based on the performance of the group using population-based measures related to clinical quality, patient experience and value.

MedPAC, an influential commission that advises Congress on matters related to Medicare, had previously discussed repealing MIPS, but yesterday’s vote marked a formal action. The recommendation will be published in the advisory commission’s annual March report to Congress. It would require a vote of Congress to nix the MIPS program.

Providers immediately reacted to the move to end the MIPS program, which began its second year January 1.

“MedPAC voted today to recommend repealing MIPS. We all get why,” said the MGMA’s Senior Vice President for Government Affairs Anders Gilberg in a Twitter post. “However, it’s alternative would conscript physician groups into virtual groups and grade them on broad claims-based measures. A poor replacement. Physicians need to be in driver seat for Medicare payment reform.”

AMA President David O. Barbe, M.D., also spoke out against the move to get rid of MIPS. “The AMA agrees that MIPS needs to be simplified and has methodological issues that are problematic for physicians,” he said in an emailed statement.

“The best remedy is to fix MIPS rather than jumping into another sweeping change that has not been fleshed out and would have many of the same methodological issues as MIPS,” he said, instead urging Congress to pass the AMA’s proposal to provide the Centers for Medicare & Medicaid Services with the time and flexibility to address MIPS issues.

The Alliance of Specialty Medicine, which represents more than 100 specialty physicians and subspecialty societies, sent a letter (PDF) earlier this week prior to yesterday’s meeting urging MedPAC not to recommend elimination of MIPS.

Critical information missing for doctors

Meanwhile, when it comes to MIPS, both the MGMA and AMA say a critical piece of information is missing for doctors—whether they are in or out of the program in 2018.

The MGMA this week sent a letter (PDF) to CMS administrator Seema Verma requesting that the agency immediately release 2018 MIPS eligibility information, including exemptions under the low-volume threshold and special status as nonpatient-facing or hospital-based organizations. In 2018, CMS significantly expanded the low-volume threshold to exclude clinicians with $90,000 or less in Medicare Part B allowed charges or 200 or fewer patients. 

Last year, CMS didn’t release eligibility information until April. But this year, MIPS quality reporting has increased from 90 to 365 days and mandates a full-year of quality reporting starting Jan. 1.

“This decision requires immediate action by physician practices. We are extremely concerned that despite being held accountable for reporting that began more than a week ago, physicians do not have basic eligibility information to determine whether they are even included in the MIPS program,” Gilberg wrote.

“For medical group practices that manage reporting for dozens or even hundreds of clinicians under the program, this information is vital to the complex clinical and administrative coordination necessary to participate in MIPS,” Gilberg said.

In an interview with FierceHealthcare yesterday, Barbe said many practices are “on the bubble” when it comes to whether they will be exempt from MIPS participation under the new threshold. “We want Medicare to be clear which practices are exempt,” he said. “We need more definitive information about who is in and who is out.”