The Medicare Payment Advisory Commission (MedPAC) recently recommended that the Merit-based Incentive Payment System (MIPS) be replaced with a proposed program that would be less burdensome and more likely to improve quality.
The commission voted during its Jan. 11-12 meeting(www.medpac.gov) to recommend replacing MIPS -- one of two tracks in CMS' Quality Payment Program -- with a proposed Voluntary Value Program (VVP).
Commissioners said MIPS is too flawed to achieve CMS' goals of reducing overall costs and improving patient care.
"We came to the conclusion that, no, it's simply not fixable for the reasons of cost, the reporting requirements, the burden on practicing physicians, the fact that it was very likely that the quality data was not going to be relevant and salient and useful," said MedPAC Chair Francis "Jay" Crosson, M.D.
Commissioners were concerned that because MIPS allows physicians to select the quality measures they want to be graded on, there is little basis for data comparison and the system encourages selection of measures where high scores can be achieved.
"It's not going to improve quality, and it's not going to improve value. It's an incredible burden for physicians," said Commissioner Rita Redberg, M.D., M.Sc. " I think we all want to achieve value, and this is just not going to do it."
The VVP, on the other hand, would rate practices on measures that include clinical quality, patient experience and value using data that CMS already possesses, which would reduce the reporting burden on physicians. It could conceivably be implemented by 2020 as a transition phase for physicians before they are ready to move into a more advanced payment program.
The program would incorporate virtual groups, such as physicians who practice at the same hospital or who are members of the same local medical society.
Some commissioners also wanted to ensure that any new payment model would help physicians who care for patients with greater medical needs move into a more advanced payment model.
"We want to be sure that those who are serving more socioeconomically disadvantaged populations are not going to end up hurt by this, so we would consider a model in which those who come together voluntarily and serve such a population might actually get a higher payout," said Commissioner Dana Gelb Safran, Sc.D.
The commission, which is charged with making policy recommendations to legislators, acknowledged that substantial details need to be worked out before the VVP could be presented to Congress.
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