With the passage of the “Medicare Access and CHIP Reauthorization Act” (MACRA), which was combined and reformed to create the “Merit-Based Incentive Payment System” (MIPS). Paul Ginsburg, Director of the USC Brookings Schaeffer Initiative for Health Policy introduced the discussion “Can MIPS be salvaged?” at Brookings.
Two panels on July 20, 2018 discussed how MIPS is working and if not, how should MIPS be reformed? Moderator Kavita Patel MD, a nonresident fellow at the Brookings Institution https://www.brookings.edu and a primary care internist at Johns Hopkins Medicine https://www.hopkinsmedicine.org said, “The complex metrics of the MIPS incentive system has done little to change the way physicians approach care.
Addressing the needs in rural areas, Valinda Rutledge, Vice President, Public Payor Health Strategy, Care Coordination Institute, at Greenville Health System https://www.ghs.org in South Carolina, reports that a unique situation exists in South Carolina as 32% of practices are in rural areas and many of these small rural practices lack connectivity and clinical integration with other rural providers.
As she explained, “Despite achieving a high enough MIPS score to be eligible for the exceptional performance bonus, network physicians received a 1.59% positive payment adjustment which calculated out to be equal to 60 percent of all costs expended which is not enough to cover the increased expenditures and staff time to comply with MIPS.”
As Vice President for Governmental Affairs and Medical Practice at the American College of Physicians https://www.acponline.org, Shari Erickson, has been hearing from physicians that they lack trust that MIPS will improve care as health IT in terms of interoperability is often missing. In addition, clinician’s engagement and understanding is lacking due to the complexity of the program.
Aaron Lyss Director of Strategy and Business Development, at Tennessee Oncology https://tnoncology.com feels that the complexities of MIPS make it hard for organizations to adapt. Also, he reports, “MIPS is insufficiently nuanced for specialists, doesn’t address patient safety, workforce health, and in addition doesn’t adequately address cost of care and outcomes.
Looking at MIPS from the business viewpoint, Tim Gronniger, Senior Vice President of Development and Strategy at Caravan Health https://caravanhealth.com reports, “MIPS isn’t working because of administrative problems, too much staff time is required, and also the IT resources needed are not being adequately addressed. So Congress should discard MIPS in order to develop an alternative approach that will produce a truly value-based purchasing program.
The second panel with Paul Ginsburg moderating, asked the panelists the question, Should MIPS be reformed? Panelists included Jim Mathews, Executive Director, MedPAC www.medpac.gov, Matthew Fiedler, Fellow, The Bookings Institution https://www.brookings.edu, Sara Levin Staff Member, for the House Committee on Ways and Means https://waysandmeans.house.gov, and Robert Horne, Senior Director, Leavitt Partners https://leavittpartners.com.
Comments ranged from eliminating MIPS unless it is replaced with a value-based program, the program is not fixable at all, some panelists felt that MIPS is fixable only if Congress addresses the problems and examines the results from the first year. Also, panelists suggested that there is not enough return on ROI along with the fact there are major differences between rural providers and large integrated practices that really need to be studied for MIPS to work.
In general, both panels agreed that while MIPS has been disappointing so far, there is still a difference of opinion as to whether to fix the program in several ways or simply to replace MIPS altogether.