During the January meeting of the Medicare Payment Advisory Commission (MedPAC), staff and Commissioners discussed the Merit-based Incentive Payment System (MIPS), among other hot topics. The commissioners proposed to eliminate the current Merit-based Incentive Payment System and in its place put a new voluntary value program in fee-for-service Medicare in which clinicians can elect to be measured as part of a voluntary group and clinicians in the voluntary groups can qualify for a value payment based on their group’s performance on a set of population-based measures.
Two commissioners did vote against the proposal, with several others expressing concern about developing a new voluntary program, but overall, the recommendation was approved.
During the staff presentation by Kate Bloniarz, Ariel Winter, and David Glass, the Commission’s concerns with MIPS from the December meeting were highlighted, especially the fact that MIPS does not meaningfully measure for quality and proves to be overly burdensome on physicians, outweighing the potential for savings. Kate Bloniarz explained that MIPS will not succeed in helping beneficiaries choose physicians or efficiently reward physicians based on value due to inadequate performance measuring metrics.
Therefore, the staff proposed that MIPS should be replaced by a new voluntary value program (VVP) that would require physicians to form, and be judged in, small groups based on a set of population health measures. While a VVP would automatically withhold two percent of every physician’s Medicare fee-for-service (FFS) payments, the staff explained there would be opportunity to earn back their payment based on performance. They went on to explain that benefits of a VVP would include a shift from clinician reporting to group level evaluation (and reward) based on patient satisfaction and outcome data. Bloniarz explained that a new VVP could also act as an “on-ramp” for physicians who wish to join an Advanced Alternative Payment Model (A-AMPs).
Commissioners voiced concern over the second recommendation regarding the elimination of MIPS and the implementation of a new VVP, with Commissioner Alice Combs and Commissioner David Nerenz voting against the recommendation. While it was widely agreed upon that MIPS was flawed and contained fundamental inequities that needed restructuring, some Commissioners were hesitant to accept the recommendation without additional adjustments.
Commissioner Kathy Buto raised the concern that socioeconomic disparities between patient bases could create a discrepancy between physician performance outcomes under VVPs. Commissioner Buto also expressed her concern that VVPs may be unattractive to those who cannot get in to an A-APM, making her hesitant to support completely eliminating MIPS. Commissioner Warner Thomas mentioned that the lack of support from the physician community to eliminate MIPS should serve as a reminder to the Commission that doing so may not be a necessity.
Commissioner Nerenz expressed concern that a VVP may not be truly voluntary, forcing physicians to form performance groups without any evidence to support that performance will be improved. In terms of beneficiary involvement, Commissioner Nerenz said that beneficiaries care less about VVP measures, and rely more on ‘’word-of-mouth” recommendation when selecting a health care physician.
On a related topic, all commissioners did vote to recommend that Congress increase the Calendar Year 2018 payment rates for physicians and other health professional services by the amount specified in current law.