CMS agrees with complaints about MACRA

A top CMS official agrees with a congressional advisory panel that MACRA's payment model should focus more on outcomes and less on performance and says the agency will seek input from providers on changing the measurements.

The Medicare Payment Advisory Commission last week said that MIPS, the Merit-based Incentive Payment System created by MACRA, should be repealed because it weighs too heavily on how doctors perform, such as whether they ordered appropriate tests or followed general clinical guidelines, rather than if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. It argues the payment system won't push physicians to truly improve outcomes and should be replaced. Dr. Kate Goodrich, chief medical officer of CMS' Center for Standards and Quality said on Friday that she agreed with the criticism but did not go so far in saying MIPS should be repealed. "There are more outcomes measures in the MIPS portfolio than I think people realize, but it is still too heavily weighted on process measures" Goodrich said at a MACRA summit. The agency's disinterest in an outright repeal of MIPS, which was created by a GOP-controlled Congress during the Obama administration, is good news for providers who view the program as a way to get more Medicare payments in the near term, according to Dr. Michael Munger, president of the American Academy of Family Physicians. Under MIPS, doctors can earn a bonus or penalty of 4% of their reimbursement in 2019. It's unclear how soon it would take to get bonus payments under a replacement model. MedPac proposed that instead of MIPS, all Medicare physicians remaining in fee-for-service should have 2% of their payments withheld. Providers could get their money back if they joined a group of clinicians evaluated on performance-based measures, such a mortality rates of patients or rate of per beneficiary spending following hospitalization. Goodrich said the proposal was intriguing but would require legislation. The CMS has the authority to develop new measures that evaluate outcomes over process and is working aggressively to do so, Goodrich said. She called it a priority for her division and that of her boss, CMS Administrator Seema Verma. The agency in the coming weeks plans to request proposals from providers and other stakeholders. The agency will pay those who submitted proposals that are ultimately developed into new measures not only for MIPS but alternative payment models as well. "If we are holding providers accountable for outcomes, they have got to be at the table and help drive this change," Goodrich said. She does, however, believe that it will be a challenge to create outcome measures that clinicians agree are integral. Goodrich has heard from specialists that they only want to be held accountable for procedures they do. For example, an orthopedic surgeon should only be held responsible for their knee replacement and any follow up negative or positive outcomes that come from it, versus general medical factors that they aren't responsible for. Providers are likely to jump at the chance as many agreed that new measures are needed. "The CMS appearing to shift away from process measures that do little more than contribute to physician burnout and increase the cost of care delivery is a welcome development," said Dr. Jerry Penso, AMGA's president and CEO. "It's important that quality measures contribute to a true understanding of the care provided and not just serve as a compliance exercise." There is also hope that the CMS will simplify patient data requirements under the program. MIPS requires the collection claims data up to a year after care is delivered largely for payment purposes, not quality improvement, according to Anders Gilberg, senior vice president of government affairs for the Medical Group Management Association. "MIPS is an overly complex rear-view mirror data reporting program that isn't clinically relevant to the majority of physicians,"Gilberg said. "[It] doesn't provide actionable clinical feedback to help physicians improve quality." An​ edited​ version​ of​ this​ story​ can​ also​ be​ found​ in​ Modern​ Healthcare's​ Oct.​ 16​ print​ edition.

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