Let CMS Pilot MedPAC's Idea to Reform MIPS, Economist Suggests

CMS should use its Center for Medicare & Mediciad Innovation (CMMI) to pilot a proposal from the Medicare Payment Advisory Commission (MedPAC) to reform the Medicare Access and CHIP Reauthorization Act of 2015, or MACRA, according to a senior fellow at Project HOPE.

Gail Wilensky, PhD, writing in The New England Journal of Medicine, said a pilot based on the proposal that MedPAC submitted to Congress would provide “real-world evidence” as to whether or not its idea to eliminate the Merit-Based Incentive Payment System (MIPS) is an improvement.

In January, MedPAC recommended repealing and replacing MIPS, 1 of 2 reimbursement tracks that physicians can enroll in under MACRA. The committee called for MIPS to be replaced with a Voluntary Value Program (VVP), where 2% of clinicians' payment would be withheld if they were not enrolled in an advanced alternative payment model or chose to be evaluated on certain population-based measures.

Wilensky said a pilot would test whether the VVP is better than MIPS in terms of helping clinicians with improving their practice and identifying healthcare organizations that provide good outcomes for beneficiaries.

A pilot could also:

• Test whether CMS can perform the claims payment and other analyses that would be required.
• Test a primary care advanced payment model proposed by the American Academy of Family Physicians and recommended by MACRA's physician payment technical advisory group.

Wilensky wrote that while she agrees with the concerns raised by MedPAC, she likewise has concerns with their proposal to jettison MIPS altogether, citing a lack of support from medical associations, the political realities of a divided Senate and upcoming midterm elections that will make the passage of any legislation difficult, and the fact that no one knows whether the proposal will work as planned or what the unintended consequences might be.

MACRA was passed with bipartisan support.

CMS could work with different stakeholders to “develop a small set of metrics that better reflect outcomes that matter to patients. All payers could then be encouraged to use this reduced set of metrics,” Wilensky wrote.

Reference

Wilensky, GR. Will MACRA improve physician reimbursement? [published online February 28, 2017] N Engl J Med. doi: 10.1056/NEJMp1801673.