Policy Watch

Changes sought for MIPS include the addition of specialist-focused quality measures and a reduction in the number of measures that rural physicians must report.

July 26—Members of Congress and some physician leaders urged the continuation of Medicare’s Merit-based Incentive Payment System (MIPS) amid growing calls for its elimination. However, many agreed the system needs changes.

The Centers for Medicare & Medicaid Services (CMS) continues to implement MIPS, a component of the Medicare Access and CHIP Reauthorization Act (MACRA). CMS will hold an Aug. 1 webinar for clinicians titled “MIPS Improvement Activities Performance Category for Year 2 Overview.”

The implementation efforts come amid calls by some to end or replace MIPS due to operational problems and concerns that many small and rural clinicians will never succeed under the system. Clinicians are assessed either bonuses or cuts as a percentage of their overall Part B payments based on their performance in four categories: quality, resource use, meaningful use of electronic health records (EHRs), and clinical practice improvement activities.

In January, the Medicare Payment Advisory Commission (MedPAC), which is Congress’s primary Medicare advisory group, voted to recommend repeal and replacement of MIPS.

Under MIPS, “given the complexity of reporting, the cost and expense, for example, we would imagine that the larger, more well-financed practices would do better at the expense of the smaller physician practices,” Francis Crosson, MD, chairman of MedPAC, said before the January vote.

The pushback against MIPS also came amid repeated CMS expansions of the number of physicians who are exempt from MIPS reporting requirements and payment changes. More than 60 percent of physicians paid by Medicare now are exempt.

But five physician leaders told Congress during a July 26 hearing that MIPS should be modified, not terminated or replaced.

“MIPS can and should be fixed; it should not be discarded,” Kurt Ransohoff, MD, chairman of the board for America’s Physicians Groups, testified to the House Energy and Commerce Committee’s Health Subcommittee.

Parag Parekh, MD, chair of the government relations committee for the American Society of Cataract and Refractive Surgery, said he found successful MIPS participation “has not been very difficult,” thanks to an EHR system that helps to track his performance on MIPS measures.

The low participation levels in MIPS indicate current participants are generally “true believers” in value-based care, while nonparticipants don’t believe MIPS is relevant to them “and aren’t making any efforts to change,” said Ashok Rai, MD, chairman of the board of the American Medical Group Association.

MIPS participation “is doable, it’s just people don’t want to do it,” Rai, an internist, said.

However, he noted that practice changes, such as the evolution to team-based care and the implementation of an effective EHR, are “not inexpensive.”

The low MIPS participation also has hurt the ability of high-scoring practices to benefit from MIPS bonuses after having made large investments to improve their performance. Since the program is revenue-neutral, successful practices under MIPS have said the low volume of participants has reduced the available bonus amount to far less than they were planning.

Changes Sought

The physician leaders did urge changes to MIPS, including the addition of quality measures focused on surgical care.

“They are measuring primary care, so it doesn’t surprise me that primary care says everyone should be in MIPS,” said Frank Opelka, MD, medical director of quality and health policy for the American College of Surgeons. “But it also doesn’t surprise me when surgical care says, ‘It doesn’t matter to the patients I’m treating, so why am I spending money in my practice to send CMS data on tobacco cessation, immunization rates.’”

If MIPS moved beyond measuring “silly things,” then more surgeons would participate in it, Opelka said.

Ransohoff, an internist, also urged CMS to require rural practices to meet fewer measures to successfully participate in MIPS.

To bring more physicians into MACRA generally, CMS needs to approve physician-focused advanced alternative payment (APMs) models, Ransohoff said. Physicians who qualify for MACRA’s APM track garner 5 percent annual bonus of their total Part B payments instead of possibly facing cuts under MIPS. However, CMS has not approved for testing any of the models recommended by the Physician-Focused Payment Model Technical Advisory Committee (PTAC), which was created by MACRA to boost the number of physician-focused models.

Ransohoff warned the committee that physicians hoping for APM bonuses will have only three more years to garner those payments after this year.

“We still don’t have a model that physicians can embrace and use,” Ransohoff said at the hearing.

Rep. Michael Burgess (R-Texas), chairman of the subcommittee, said he plans a future hearing with CMS officials to ask about the fate of PTAC models.

Responding to questions after a speech this week, Seema Verma, administrator of CMS, said she plans to waive more program integrity rules and offer new APMs for primary care physicians.

Monday, July 30

Deadline for applications to the Centers for Disease Control and Prevention (CDC) Workforce Improvement Project. Learn more.

Deadline to apply for Health Resources and Services Administration funding to develop prevention programs for opioid use disorder. Learn more.

10th Annual National mHealth, Telemedicine & Virtual Health Care Congress (through Aug. 1). Learn more.

Comments due for the CMS Home Health Pre-Claim Review Demonstration Model. Learn more.

3rd Annual Population Health Analytics Summit (through Aug. 1). Learn more.

4th Annual Employer-Health System Direct Contracting & Strategic Partnerships Summit (through July 31). Learn more.

Tuesday, July 31

Hearing by the Senate Health, Education, Labor, and Pensions Committee titled “Reducing Health Care Costs: Decreasing Administrative Spending.” Learn more.

Wednesday, Aug. 1

Webinar by CMS titled “Promising Practices for Meeting the Behavioral Health Needs of Dually Eligible Older Adults.” Learn more.

Webinar by AHIP titled “Advancing a Clinical Data Strategy: Examples with Impact.” Learn more.

Thursday, Aug. 2

Webinar by AHIP titled “Enabling Quality Management Beyond Reactive HEDIS Regulatory Compliance.” Learn more.


Rich Daly is a senior writer/editor in HFMA’s Washington, D.C., office. Follow Rich on Twitter: @rdalyhealthcare

Publication Date: Thursday, July 26, 2018