MIPS named top regulatory burden for physician practices

When asked to identify what regulations are the most burdensome, physician practices pointed at the Merit-based Incentive Payment System (MIPS) being implemented as part of the Medicare Access and CHIP Reauthorization Act (MACRA).

Of the 750 group practices responding to the Medical Group Management Association (MGMA) survey, 82 percent called the new Quality Payment Program “extremely” or “very” burdensome. Only 1 percent said the new payment tracks in the QPP, including MIPS, weren’t a burden.

Diving down into their complaints, most respondents said they’re very or extremely concerned about the relevance of MIPS to patient care (80 percent) or specialty care (78 percent), see the MIPS scoring system as very or extremely complex (73 percent) and view it as a “government program that does not support their practice’s clinical quality priorities” (74 percent).

“The resources it will take to comply with MIPS are absurd, and the only thing the program measures is the ability to meet documentation requirements,” one respondent said.

Other MIPS concerns included overall implementation costs (71 percent), unclear program guidance (69 percent) and timely feedback (67 percent). MGMA expressed similar concerns earlier in 2017 after a delay in notifying clinicians about their MIPS eligibility. Only 40 percent of respondents were very or extremely concerned about vendors being ready to provide MIPS tools, which have been one of the biggest requests from attendees for the upcoming MGMA conference in October.

“If there are products and services specifically designed for MIPS and MACRA—and I believe there are a few consulting services that focus on that—then yes, those are going to be hot button items,” MGMA’s assistant director of project management, Joan Hablutzel, MBA, told HealthExec.

While MIPS is seen as a burden, it’s not stopping those same respondents from pursuing positive payment adjustments through the program. 84 percent said they’ll be MIPS participants in 2017, during which clinicians have “pick your pace” options available. Only 20 percent of respondents, however, said they’ll report the minimum amount of information to avoid a negative adjustment in 2019. 31 percent said they’ll report additional data to aim for a modest positive adjustment, while 40 percent said they’ll report on a full set of MIPS data to qualify for an exceptional performance bonus.

Few of the respondents appear to be going into the QPP’s other payment track, Advanced Alternative Payment Models (AAPMs). 40 percent said they weren’t sure, while 36 percent gave other answers. The most common model being utilized was Comprehensive Primary Care Plus (CPC+), with 13 percent of respondents planning to participate in 2017.

Outside of MIPS and MACRA, the next biggest burdens were lack of national electronic attachment standards (74 percent), audits and appeals (69 percent), and lack of EHR interoperability (68 percent), though some of those concerns play into providers’ headaches about the new payment tracks.

“EHR vendors continue to charge addition[al] fees for a ‘package’ to meet MIPS reporting requirements. It’s a gold mine for them,” said one respondent.

MGMA President and CEO Halee Fischer-Wright, MD, said the group is looking forward to working with Trump administration on “meaningful solutions” to remove “excessive regulations,” which it said costs nearly half of responding practices more than $40,000 per full-time-equivalent physician, per year, for compliance. The new administrations at HHS and CMS have asked for comments and suggestions on deregulation and have already taken action aimed at reducing the burden in MIPS by raising the low-volume exemption threshold, allowing more clinicians to stay out of the program.