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MedPAC, no longer content to reform MIPS, calls to replace it with 'voluntary' program

MedPAC makes a bold recommendation for the merit-based incentive payment system (MIPS): Get rid of it.

In an Oct. 5 public meeting, representatives from MedPAC, the independent federal body that reviews and makes non-binding recommendations on Medicare policy, Kate Bloniarz and David Glass gave a presentation that assessed MIPS, through which most Medicare providers who take part in the mandatory Quality Payment Porgram (QPP) will report and be scored and rewarded or penalized. The presentation noted MIPS' "significant burden on clinicians" and other alleged failings, including scoring that is "inequitable across clinicians."

The presenters suggested as an alternative "policy option" that CMS "eliminate MIPS and create [a] new voluntary value program." That program would only be "voluntary" in a sense, though: all clinicians who aren't in an advanced alternative payment model (APM) would have 2% of their fee schedule payments withheld, which they could win back as a "value payment" via enrollment in a new program that would judge performance by simple metrics such as "spending per beneficiary after a hospitalization" and "[patients] able to communicate concerns to clinician."

MedPAC had given MIPS a negative review in June 2017, saying "as presently designed [it] is unlikely to succeed in helping beneficiaries choose clinicians, helping clinicians change practice patterns to improve value or helping the Medicare program reward clinicians based on value." Some of their specific concerns -- that many providers would attest only to measures on which they were likely to do well, and "as a result, it will be difficult to ascertain any distinction among clinicians on their performance" -- were repeated in the Oct. 5 presentation.

"Creating a better design for MIPS and [advanced APMs] could help achieve Medicare’s goals of improving quality for beneficiaries, making payments fair for clinicians, and restraining program costs for taxpayers," said MedPAC in that earlier presentation. Apparently in the four months since then, they lost whatever faith they had that CMS would make such improvements. 

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