A refresher may be in order of what the acronyms mean and their purposes.
The Medicare Payment Advisory Commission (MedPAC) is an independent US federal body. MedPAC was established by the Balanced Budget Act of 1997 (P.L. 105-33). The Commission’s 17 members bring diverse expertise in the financing and delivery of health care services. Commissioners are appointed to three-year terms (subject to renewal) by the Comptroller General of the United States and serve part-time. Its primary role is to advise the US Congress on issues affecting the administration of the Medicare program. Specifically the commission’s mandate is to advise the US Congress on payments to private health plans participating in Medicare and health providers serving Medicare beneficiaries. MedPAC is also relied on by Medicare administrators and policy makers to evaluate beneficiary’s access to care and the quality of care received. MedPAC’s mandate is broad enough that it can also evaluate other issues affecting Medicare.
MedPAC produces two major reports to the United States Congress each year that contain recommendations to improve Medicare. Source: Wikipedia
The Merit-based Incentive Payment System (MIPS), part of the Quality Payment Program (QPP), is designed to provide incentive to Medicare providers to provide high quality, efficient care supported by technology. Scores may earn a performance-based payment adjustment to Medicare payments. Source: QPPCMS.gov
MedPAC wants to junk MIPS as it feels that it’s too much of a burden for physicians and won’t push them to truly improve care. The CMS estimates that up to 418,000 physicians will be submitting 2017 MIPS data.
But MIPS is severely flawed, according to MedPAC. It is designed primarily to measure how doctors perform, such as whether they ordered appropriate tests or followed general clinical guidelines, rather than if patient care was ultimately improved by that provider’s actions. According to David Glass, principal policy analyst at MedPAC,
“Time is of the essence to develop an alternative for MIPS, it will not achieve the goal of identifying and rewarding high-value clinicians.”
Another flaw is that MIPS lets clinicians choose the measures under which they’re evaluated. The concern is that they’ll choose measures on which everyone tends to perform well. There are more criticisms in an article in Modern Healthcare
In place of MIPS, the commission suggested a new program: a portion of payments (perhaps 2%) is withheld. Providers not in an advanced payment model (APM) could join a group of physicians whose claims data is reviewed on certain population-based health measures to see if they qualify to have the withheld funds returned. Providers who do not participate in an APM or the new model would forfeit the withheld portion.
Providers generally have mixed feelings about MIPS. Most want to push toward value-based payment models, but find flaws in MIPS, particularly the heavy reporting requirements. In response, a recent MACRA proposal would exempt more small providers from the program, leaving about 36% of clinicians eligible for participating next year. In comments to this proposed rule, provider groups suggested tweaks like allowing more advanced alternative payment models to quality for MACRA. Read the perspective and insights from HealthcareDive