NEW ORLEANS—Even the highest-performing physicians and practices will see a “piddly” payment adjustment under the Merit-based Incentive Payment System (MIPS).
Doctors who scored the maximum 100 points under MIPS will end up with a payment adjustment in the 1.6% range in 2020, according to an estimate from the Medical Group Management Association (MGMA).
While MIPS is burdensome to practices, participants will get a payment increase that Drew Voytal, an associate director for government affairs at the MGMA, called “piddly” and “miniscule”—one which the MGMA estimates will amount to around just 1.6%.
At the same time, over 76% of medical group practices in an MGMA survey said MIPS is “incredibly burdensome,” Voytal told an audience at the group’s annual conference in New Orleans Monday.
With responses from more than 400 medical group practices, the MGMA’s annual regulatory burden report found 87% reported MIPS payment adjustments do not cover the costs of time and resources spent participating in the program.
While survey respondents said prior authorization requirements ranked as the top regulatory burden for practices, Medicare’s Quality Payment Program, which includes MIPS, was a close second.
“It’s an obstacle course for practices,” Voytal said about MIPS.
Practices that submitted 2018 MIPS data can now view their performance feedback and scores on the Quality Payment Program website at www.qpp.cms.gov/login. The 2018 performance data will determine 2020 payment adjustments.
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A feature, not a bug
MIPS payment adjustments are low in part because of the way the system is designed.
This year, the highest-scoring physicians ended up with a 2.02% payment adjustment.
According to the Centers for Medicare & Medicaid Services (CMS), 98% of 2018 MIPS participants avoided a penalty by accruing enough points by reporting quality and other data. While performance allows practices to achieve high scores in the MIPS program, they are often investing in additional resources from personnel to technology.
By statute, MIPS must be “budget neutral,” meaning payment adjustments for high-performing practices and physicians must come from the penalties from those who fail to participate or perform poorly. A penalty results in a cut in Medicare reimbursement—money that can fund incentive payments to others.
“There just isn’t a mechanism to award high performance,” Voytal said.
With that setup, a member of the audience said practices are pretty much participating in MIPS just to avoid a penalty, not to achieve a performance adjustment payment.
“Pretty much,” admitted Voytal.
If everyone avoids a penalty, there is not a lot of money to award high performers.
“MIPS is getting off the charts intrusive and burdensome,” said one survey respondent.
Another said their practice pays its electronic health record vendor $300 each month for a MIPS adviser. “I agree with improving patient care and improving communication with other physicians. However, the process and amount of information can be reduced and simplified,” the respondent said.
What docs are saying
The MGMA survey found practices are critical of the Quality Payment Program. Not only is there no return on investment, 84% of respondents reported that CMS' implementation of value-based payment has increased the regulatory burden on their practice. Over three-fourths of respondents noted CMS' feedback on MIPS cost and quality measure performance is not useful in reducing costs or improving clinical outcomes.
"Value based reforms have tremendous promise to support physicians who provide high quality, low cost care," said Anders Gilberg, senior vice president of government affairs at MGMA. "However, in order to be successful, the government needs to provide medical groups with clinically relevant and actionable patient data. As evidenced by this survey, there’s still much work to be done."
The proposed physician fee schedule released by CMS in July makes few changes to MIPS, Voytal said. While that’s good news in that practices won’t have to adjust to new rules, it’s bad news for those who hoped for improvements to MIPS, he said.
CMS is expected to release a final rule on the physician fee schedule by Nov. 1.
MGMA conducted its survey to look at the impact of federal regulations on the U.S. healthcare system.
A vast majority (86%) of respondents reported the overall regulatory burden on their medical practice has increased over the past 12 months. Even more respondents (96%) agreed a reduction in regulatory burden would allow their practice to reallocate resources toward patient care.
"Medical group practices continue to struggle with overwhelming regulatory burden," said Gilberg. "Precious time and resources are being diverted from patient care to keep up with the deluge of administrative requirements."
Number one on the list of regulatory burdens are the growing challenges with prior authorization, including issues submitting documentation through fax or a health plan’s proprietary web portal, as well as changing medical necessity requirements and appeals processes to meet each health plan’s requirements, MGMA said.
As one survey respondent noted, "During the past year we have added three new employees to handle just the prior authorization requirements."