MedPAC votes to recommend repealing MIPS

Following up on criticisms of the Merit-based Incentive Payment System (MIPS) at recent meetings, the Medicare Payment Advisory Commission (MedPAC) formally voted to recommend scrapping the payment system, arguing the program replicates flaws from those it was meant to replace.

In a presentation at the Jan. 11 meeting, MedPAC policy analysts Katie Bloniarz, MS, Ariel Winter, MPP and David Glass, MS, wrote that the program, one of the new payment tracks set up by the Medicare Access and CHIP Reauthorization Act (MACRA), is “burdensome and complex,” focused on reporting information which isn’t meaningful and resulting in scores which aren’t comparable across clinicians.

“MIPS will not succeed in helping beneficiaries choose clinicians, helping clinicians change practice patterns to improve value or helping the Medicare program to reward clinicians on value,” the presentation read.

By a 14-2 vote, commissioners recommended that Congress eliminate MIPS. In its place, MedPAC has proposed the Voluntary Value Program (VVP), where 2 percent of clinician payment would be withheld unless clinicians either joined an Advanced Alternative Payment Model (AAPM) or elect to be measured as part of larger group on “population-based measures assessing clinical quality, patient experience and value.”

The VVP, MedPAC analysts wrote, would provide an “on-ramp” to prepare clinicians to participate in the AAPM track of MACRA.

The move has its supporters. Ashish Jha, MD, MPH, professor of health policy at the Harvard T.H. Chan School of Public Health, tweeted MedPAC was “completely right” in its assessment of MIPS.

Plenty of stakeholders have complained about MIPS, also calling it too complex, too burdensome in its second year or, alternatively, too flexible because the majority of providers will be exempted from the program this year. But some of the same groups are opposed to MedPAC’s recommendation on getting rid of it altogether.

“MGMA shares MedPAC’s concern that aspects of the current MIPS program are unduly burdensome and impede patient-centered care and innovation. However, we believe its recommendation to eliminate the program fails to adequately address the problem and does not reflect the current value-based landscape,” Anders Gilberg, senior vice president of government affairs at the Medical Group Managmement Association (MGMA), said in a statement to HealthExec. “MedPAC’s alternative that would conscript physician groups into virtual groups and evaluate them on broad claims-based measures is inconsistent with the congressional intent in MACRA to put physicians in the driver seat of Medicare’s transition from volume to value.”

The MedPAC decision doesn’t come with any binding authority. The group is tasked with providing Congress and CMS with guidance and analysis, and its recommendations have been ignored before, such as when it supported making accrediting organization surveys of hospitals public or recommended a larger increase in Medicare payments to hospitals.