MedPAC Backs Bid to Scrap MIPS Medicare Pay System Amid Dissent

Kerry Dooley Young

January 11, 2018

WASHINGTON  — Members of an influential federal advisory panel sparred here today over a recommendation that would direct Medicare to scrap its fledgling Merit-based Incentive Payment System (MIPS) and instead implement a new approach for tying reimbursement to judgements about value of care.

The Medicare Payment Advisory Commission (MedPAC) voted 14 to 2 in favor of telling Congress to do away with MIPS and moving to what the panel termed a voluntary value program. In this proposed arrangement, physicians could opt to join groups and then have their performance judged as part of this cohort.

MedPAC staff for months have argued that MIPS will burden doctors with complex data-reporting requirements, yet much of the reported information ultimately will be unlikely to improve the quality of patient care.

"MIPS cannot succeed," the MedPAC staff said in the title of one of the slides presented before the Thursday vote.

Supporters of the MedPAC approach argued for fast action, seeking to prevent what they called a flawed system from taking root in American healthcare. It will be difficult to dismantle MIPS if it becomes entrenched, said MedPAC panelist Rita Redberg, MD, a cardiologist. The doctors and hospitals that stand to benefit from MIPS likely would turn into champions for the program.

"I wouldn't want to see us start down that road," Dr Redberg said at the meeting.


Dissenting were MedPAC panelists Alice Coombs, MD, an anesthesiologist and critical care specialist, and David Nerenz, PhD, a health policy researcher. Both had raised questions about replacing MIPS at previous MedPAC meetings. They cited concerns about the burden on physicians and questions about approaches for linking Medicare payment to judgments about quality of care.

"We have not seen one specialty physician group yet say, 'You know what, I like getting rid of MIPS and I like this [Voluntary Value Program], let's go with it,' " Dr Coombs said during the meeting. "I haven't seen that and I practice in two different states, both Massachusetts and Virginia."

In fact, the American Medical Association (AMA) protested the MedPAC vote at the conclusion of Thursday's meeting, arguing to keep MIPS in place.

"Where we are is that we'd like to fix it rather than kill it," Sharon McIlrath, assistant director of federal affairs at the AMA, told the MedPAC panelists during the public comment period.

The AMA separately issued a statement from its president, David O. Barbe, MD. He asked for simplification of MIPS.

"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," Dr Barbe said. "We strongly urge Congress to pass our proposal to provide [the Centers for Medicare and Medicaid Services (CMS)] with the time and flexibility to address these issues."

Even Dr Coombs, one of the most ardent defenders of MIPS among MedPAC members, concedes that the data-reporting requirements frustrate physicians.

But she's also been an advocate for the potential benefits of MIPS in MedPAC's discussions of the new program. Physicians may dislike process measures, but they serve as reminders to more carefully consider treatment options for patients, Dr Coombs said at the December MedPAC meeting.

"Their whole attitude has changed because they now have to report," said Dr Coombs, who also argues for improving MIPS instead of replacing it. "I think the patients are better for it."

MedPAC Chairman Francis J. Crosson, MD, said he would look to incorporate additional suggestions into the MIPS recommendation in the panel's March report to Congress. Lawmakers and officials at CMS rely heavily on MedPAC's annual reports in tailoring policies for the giant healthcare program. Medicare serves about 57 million Americans.

Doubtful Outlook

It's unclear how lawmakers and CMS will greet the MedPAC recommendation on MIPS.

Lawmakers mandated MIPS as part of the bipartisan 2015 Medicare Access and CHIP Reauthorization Act (MACRA), a measure in which members of both parties still have considerable pride. That law ended recurring battles over a budget tool known as the sustainable growth rate formula that had repeatedly threatened to cause deep cuts in Medicare payments to doctors.

Congress in recent months has struggled with seemingly less complex tasks such as reauthorizing the Children's Health Insurance Program. Routine appropriations have not yet been completed for fiscal 2018, which began October 1, 2017. The AMA's McIlrath told MedPAC that it doesn't appear "politically viable to think that you are going to go up there and think that you are going to get the Hill to kill MIPS."

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