MedPAC Recommends Elimination of MIPS Program

On Thursday, January 11, the Medicare Payment Advisory Commission (MedPAC) voted to recommend eliminating the Merit-based Incentive Payment System (MIPS) under MACRA. MACRA established new payment updates, giving a 5 percent incentive payment for qualified participants in the advanced alternative payment model (APM). MIPS is a value-based purchasing program for clinicians remaining in fee-for-service. Payment is adjusted based on quality, cost, and improvement activities. MedPAC voted 14-2 to get rid of MIPS and replace it with an alternative program. 

MedPAC stated that MIPS cannot succeed because it replicates the flaws of prior value-based purchasing programs, which include its complexity, the fact that much of the reported information is not meaningful, and scores among clinicians are not being comparable. Additionally, MedPAC believes that the MIPS payments will be minimal in the first two years and then large and arbitrary in later years. MedPAC also stated that MIPS neither helps physicians nor Medicare move to value-based care. 

MedPAC recommends a new voluntary value program to replace MIPS. The proposed program would have a value component in traditional fee-for-service payment, but prepares physicians to take part in an advanced APM. It would also give them incentives as the voluntary value program would have smaller financial rewards than an advanced APM.

The program would have a withhold applied to all fee schedule payments. In past meetings, MedPAC has mentioned a 2 percent withhold. Clinicians would then elect to join a voluntary group, which would assess performance, join an advanced APM and get their withhold back, or make no election and lose their withhold. The voluntary group performance would be assessed using uniform population-based measures in all categories of clinical quality, patient experience, and value.

MedPAC has been questioning MIPS value for almost a year. The commission's recommendations are non-binding. The Centers for Medicare and Medicaid Services (CMS) has made changes in the past based on MedPAC recommendations, but also, Congress and CMS have ignored advisory opinions.

Contact Joy Cameron with any questions or concerns. 

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