July 10, 2018, 05:06 pm News Staff – CMS has announced its intention to pursue a demonstration project that, if adopted, would waive Merit-based Incentive Payment System (MIPS) requirements for physicians who participate in certain Medicare Advantage plans that require clinicians to shoulder the risk for their patients' health care spending.
According to a recent press release, the project, dubbed the Medicare Advantage Qualifying Payment Arrangement Incentive Demonstration (MAQI), is being considered for formal approval.
CMS Administrator Seema Verma, M.P.H., said in the release that the demonstration project is in sync with the agency's goal of moving the nation to a value-based health care system and "aims to put Medicare Advantage on a more equal playing field with fee-for-service Medicare."
As family physicians know, the Medicare Access and CHIP Reauthorization Act provides two tracks for physician payment under Medicare. Physicians can participate in MIPS by reporting quality data to CMS and receive an upward or downward payment adjustment, or seek out an Advanced Alternative Payment Model (Advanced APM) and agree to take on risk.
As the release points out, some Medicare Advantage plans are experimenting with arrangements that look similar to Advanced APMs, but physicians participating in those plans would still be subject to MIPS rules if the demonstration project is not implemented.
"CMS intends to test whether MIPS exemptions provided to clinicians under MAQI will increase participation in Medicare Advantage plans that are similar to Advanced APMs and thereby accelerate the transition to a health care system that pays for value and outcomes," said Verma.