CMS makes first move to hold docs accountable for Medicare spending

The CMS is taking its first steps to evaluate whether MACRA will lead to reduced Medicare spending with a new pilot test.

The test will evaluate eight new measures to determine if physicians in the Merit-based Incentive Payment System, known as MIPS, are actually reducing the cost of care. The CMS unveiled the initiative just two weeks after the Medicare Payment Advisory Commission suggested repealing MIPS over concerns it wouldn't lead to better quality of care for patients or lower costs. Under MIPS, providers become eligible for either bonus payments or penalties based on their performance, including evidence of quality improvement, cost reduction or maintaining current levels of spending; efficient use of electronic medical records; and clinical improvement activities such as later office hours and greater use of care coordination Two years into the law's rollout, the CMS still hasn't outlined exactly how providers will be judged under the cost metric as the agency continues to develop specific measures to see if doctors are reducing spending. The new CMS pilot test will track cost data for eight procedures and medical conditions including percutaneous coronary intervention, knee arthroplasty, cataract removal, lower limb revascularization, colonoscopy, intracranial hemorrhage and pneumonia. As part of the experiment, the CMS has created reports for around 17,000 medical practices based on claims data from June 1, 2016 to May 31, 2017. Acumen, a research company hired by the CMS, is now reaching out to the physician groups to review their reports and complete a survey on if the data provided is accurate. Clinician feedback will be used to refine the measures prior to their use in MIPS. Practices have until November 15 to comment on their reports. Providers have grown increasingly anxious that the CMS still doesn't know how it will evaluate them on spending reduction efforts. The agency has a proposed rule out that delays compliance for the second year in a row. MACRA envisioned the CMS judging providers on cost with incredmental adjustments, with cost cutting eventually accounting for 30% of a provider's MIPS score by the third performance year of MACRA. The law did allow the CMS to waive the cost measure for two years, but by year three it has to kick in at the 30% rate, creating a steep cliff for providers who still don't know how they will be judged. Dr. Kate Goodrich, chief medical officer of the CMS' Center for Standards and Quality said the agency is aware that some clinicians are nervous that they won't know how they'll be evaluated until compliance starts. But she said there seems to be an understanding that it's best the agency develops the right measures first. "What we've heard is that cliff between 0% and 30% is worth the trade off," Goodrich told medical practice heads last week during a MACRA summit. The provider industry is concerned already that the eight measures chosen by the CMS to test may not be the right ones. "We have concerns about the complexity of the algorithms developed for the measures and how CMS will translate these cost measurements into a MIPS score given that these eight measures will not apply across the board to all [clinicians]," said Anders Gilberg, senior vice president of government affairs at the MGMA.