Physician groups warn MIPS could harm patients, doctors

Several provider groups on Thursday criticized a value-based payment program created by MACRA for potentially causing harm to patients and setting physicians up to fail, which could spark millions of dollars in financial penalties.

Members of the American College of Physicians found that just 37% of the 86 quality measures in the Merit-based Incentive Payment System would actually improve the standard of care a patient received.

The review, published Thursday in the New England Journal of Medicine, was spurred by numerous physician complaints that the measures aren't meaningful or that the administrative investments to comply with the program were going to waste, according to Dr. Catherine MacLean, lead author of the analysis and chief value medical officer at the Hospital for Special Surgery.

U.S. physician practices are spending $15.4 billion each year—about $40,000 per physician—to report on performance measures, according to researchers.

"I don't think anyone would argue that good measures that were driving health improvement are not worth the administrative costs, but when there are not good measures then it's frustrating, potentially harmful to patients and a waste of money," MacLean said.

MacLean highlighted a measure she thought was dangerous, which requires all patients to achieve blood pressure of 140/90 or lower. For some seniors, that's too low, but there is no exception to the measure.

The Medicare Payment Advisory Commission has raised similar concerns about MIPS measures and called for the program to be repealed and replaced. MacLean said the ACP isn't calling for repealing or even freezing MIPS, but wants the CMS to eliminate the problematic quality measures and find new ones that will help reach better health outcomes.

A CMS spokeswoman said the agency continually evaluates MIPS measures and is committed to reducing physician burden while maintaining the highest levels of quality and patient safety.

Hours after the release of MacLean's paper, a group of medical societies led by the Medical Group Management Association raised their own concerns about MIPS in a letter to the CMS.

This year, providers reporting under the program must do so for a full year versus last year's 90-day requirement. The medical groups said that change is problematic, especially since the CMS didn't alert some doctors about whether they needed to comply with MIPS until April.

Unlike last year, physicians must look up their MIPS status in an online database. As of Thursday, that website had not been updated with 2018 information.

The associations also noted they have heard the CMS does not plan to update the website until this summer at the earliest, which is halfway through the reporting period.

"Given the website is the primary means for educating physicians on the program, this severe delay would undermine physicians' ability to meet the 2018 requirements to successfully avoid a penalty," said the letter co-signed by officials from the MGMA, American Medical Association and others. "For small practices and medical group practices that manage reporting for dozens or even hundreds of clinicians under the program, this information is vital to the complex clinical and administrative coordination necessary to participate in MIPS."

The medical associations have asked the CMS for a 90-day reporting period for 2018, given the potential costs and work it would take to report on measures for the full year after the delay.

A CMS spokeswoman did not immediately respond to a request for comment on the proposed reporting period.

An edited version of this story can also be found in Modern Healthcare's April 23 print edition.