The fate of MIPS divides healthcare groups after MedPAC vote

Major healthcare associations had a decidedly mixed reaction to the Medicare Payment Advisory Commission (MedPAC) recommending to Congress that the Merit-based Incentive Payment System (MIPS) be eliminated, with some stakeholders saying such a major change would be premature less than three years after the Medicare Access and CHIP Reauthorization Act (MACRA) was passed.

By a 14-2 vote on Jan. 11, MedPAC recommended the program be scrapped, arguing MIPS is “burdensome and complex,” focused on reporting information that isn’t meaningful and resulting in scores which aren’t comparable across clinicians. In its place, it has proposed the Voluntary Value Program (VVP) withholding 2 percent of clinician payment unless they join an Advanced Alternative Payment Model (AAPM) or a virtual group where they’re evaluated on “population-based measures.”

Echoing earlier comments from the Medical Group Management Association (MGMA), the American Hospital Association (AHA) said the focus should be on fixing MIPS and the Quality Payment Program (QPP), not ditching it altogether.

“We believe the commission’s recommendation to replace the QPP’s (MIPS) with a new (VVP) is premature, and we have concerns about the proposed VVP’s design and feasibility. The AHA continues to urge that the commission use data and experience from the field before recommending major changes to the MIPS,” AHA’s director of policy, Akin Demehin, said in a statement to HealthExec.

American Medical Association president David Barbe, MD, MHA, agreed with MedPAC’s concerns that MIPS “needs to be simplified and has methodological issues that are problematic for physicians.” His suggested remedy, however, was for smaller tweaks “rather than jumping into another sweeping change that has not been fleshed out.” Congressional action may help, he added, if lawmakers consider the AMA’s proposal to allow additional “flexibility” for MIPS reporting through 2019.

The American College of Physicians (ACP) offered a slightly different take. In its statement to HealthExec, ACP said it supports the goals and intent of the QPP and the Medicare Access and CHIP Reauthorization Act (MACRA) and accelerating movement towards APMs. Improvements are needed in MIPS, it said, but the group neither endorsed or criticized the proposed replacement.

“The recommendations by MedPAC to eliminate MIPS—rather than work to improve the newly implemented program—and replace it with a program that could include withholding payments to doctors, using population-based measures from claims data, needs to be assessed cautiously and carefully,” ACP said. “We look forward to further evaluation of the MedPAC recommendations and remain dedicated to advancing payment reforms that deliver better quality at lower cost.”

On the opposite side of the spectrum, the American Medical Group Association (AMGA) signaled a greater willingness to consign MIPS to the scrap heap. Having criticized the greater number of clinicians exempted from the program by CMS through last year’s rule, AMGA’s vice president of policy, Chet Speed, LLM, told HealthExec it has become “a compliance exercise that has little impact on the quality of patient care.”

“AMGA members have made multi-million dollar investments to improve care and reduce costs, and if MIPS isn’t the way to move Medicare to value, it’s time to critically review the program and either remake MIPS into a true value transition tool or to move MIPS funds to Alternative Payment Models that provide real incentives for better care and reduced costs,” Speed said.

Once the elimination of MIPS and the replacement with the VVP are included in MedPAC’s report to Congress, the fate of the program will be decided on Capitol Hill. MedPAC’s vote was no binding authority, and its recommendations have been ignored before by both federal lawmakers and regulators.