MedPAC's MIPS Vote Meant to Encourage Physicians Into High-Risk Payment Models, Says Aledade's Broome

Replacing the Merit-based Incentive Payment System (MIPS) with a voluntary program should encourage providers to move quicker into more risk-based payment models, according to Travis Broome, vice president for policy at Aledade.

In January, the Medicare Payment Advisory Commission (MedPAC) had voted on repealing MIPS, which was established under the Medicare Access and CHIP Reauthorization Act (MACRA), and replacing it with the Voluntary Value Program (VVP). Under MACRA, physicians caring for Medicare patients could get reimbursed by participating in 1 of 2 tracks: MIPS or an advanced alternative payment model (APM).

There were concerns about the structure of MIPS, and Broome believes that MedPAC is addressing 2 of those concerns: first, that too many providers will stay in a safe spot that only requires them to “check the box” or do the minimum on quality measurement without advancing to something with more risk; and second, the high burden of data collection in MIPS. Broome agrees with the sentiment that too many providers would be "hanging out in the middle" without moving to an advanced APM.

Another issue MedPAC had with MIPS was that in order to use claims-based data for reporting and measurement purposes, physicians who didn’t voluntarily join a virtual group or an accountable care organization were being automatically and randomly grouped with other physicians. The solution, then, had been to incentivize providers with VVP to voluntarily join those groups. Being forced into randomly generated groups had been a huge source of pushback from providers.

“They won’t feel connected enough to a random group like that to feel they should be graded on the group’s performance,” Broome said. “Whereas, when you join a group, you know what you’re signing up for.”

He noted, though, that no one expected MIPS was simply going to stay the same. Already, MIPS had evolved faster than expected, Broome said. For instance, CMS included cost as a measurement component for 2018 when most people expected they would get another year before it was added.

Broome was also skeptical about the reality of getting rid of MIPS entirely, since it would require legislative action from Congress.

“I don’t know if there’s going to be much interest in revisiting MACRA, something that was passed with such bipartisan support,” he said. “But I do think [MedPAC's vote] really will ... hopefully, push the administration to try and encourage providers to not stay in the measurement version of value-based care.”

Broome explained that he expects to see more from the current administration in terms of risk-based models, such as a total cost of care model that looks more like Medicare Advantage and some tweaks to the Medicare Shared Savings Program.

The fact that CMS Administrator Seema Verma has said she wants to see more providers take up risk-based advanced APMs and wants to incentivize that through better designs of models and making them more attractive to physicians—perhaps by reducing administration or financial burden—has provided a lot of hope for Broome regarding the future direction of value-based care.

Ultimately, he isn’t concerned with MedPAC's vote to get rid of MIPS, because the committee still wants the physicians to continue the move toward value-based care. Instead, he viewed the vote as indicating that MedPAC felt forcing physicians into more risk was going to result in them doing the minimum necessary to avoid a negative rate adjustment.

“If physicians buy into it, choose to do it, [that] is actually when you get the change where they’ll actually try to do something different with their practices in the future than they do today,” Broome said. “Whereas, if you force them into it, then there’s just checking boxes and doing a compliance exercise.”