The Medicare Payment Advisory Commission wants Congress to scrap the new Merit-based Incentive Payment System for physicians, better known as MIPS, and replace it with a voluntary program.
The idea is to get rid of Medicare quality incentive programs that aren't working. In this case, they want to ditch one before it's even been tried.
Forget the bipartisan coalition that voted for the 2015 Medicare Access and CHIP Reauthorization Act, where legislators from both parties backed replacing the sustainable growth-rate formula with the new MIPS pay-for-performance scheme.
Ignore the millions of dollars that physician practices and hospital systems have invested in collecting the dozens of data points needed to comply with MIPS. Data collection began this year.
Pretend the CMS, in drawing up regulations for MIPS, didn't carve out multiple exemptions, and give physicians the power to pick their own quality indicators. Fewer than half of the nation's physicians will be affected by the rewards and penalties doled out by the new law.
MedPAC, in its latest annual report, concluded the program can't work and says Medicare would be better off if it gave physicians the option of joining a "voluntary value program." The advisory panel wants a program that will serve as the on-ramp for participation in alternative payment models such as accountable care organizations. Though APMs were the preferred alternatives for determining physician pay increases in the new law, only 1 in 5 physicians opted to join such programs.
While MedPAC offered few details for its voluntary program, it's more behavioral economics than true voluntarism.
The commission recommended withholding 2% of all physician fee-for-service payments. But individual docs would automatically lose that cash if they didn't join the program.
The money in turn would be doled out to participants who met pre-specified goals on outcomes measures like mortality, readmissions and preventable admissions. Performance would be determined by gleaning CMS claims records, which would eliminate burdensome new reporting requirements.
The 14 of 16 commissioners voting in favor of scrapping MIPS included some of the leading proponents of moving the healthcare system to value-based care. They argued it makes no sense to force physicians into a program that replicates all the errors of the hospital-oriented value-based purchasing program.
Critics say the penalties and rewards are too small, the quality measures do not reflect patient outcomes, and the burden of collecting the data is too great. Large, sophisticated practices, many of which are owned by hospital systems, will avoid moving into risker APMs once they start earning rewards under the new program.
Opponents also argue that physicians serving disadvantaged patients will be unfairly penalized by MIPS. And patients won't make use of the new data. "It's not going to improve quality, and it's not going to improve value," said Commissioner Dr. Rita Redberg, a cardiologist at the University of California at San Francisco and editor of JAMA Internal Medicine.
In the policy community, there appears to be broad support for ditching MIPS. Writing in the New England Journal of Medicine, former Republican CMS chief Gail Wilensky called on the CMS' Innovation Center to quickly set up a pilot project to test MedPAC's proposal.
Scholars at the Brookings Institution, writing on the Health Affairs blog, offered their own suggestions, including the creation of new incentives for joining APMs and offering rewards if practices achieve specific goals like electronic health record interoperability or joining registries that can be used to measure physician performance against best clinical practices.
It took Congress more than a decade to undo its last failed effort to change physician pay. It's barely two years in, and the battle to reform its replacement is already underway.