Researchers determine health expert is urging Medicare to quickly test an alternative approach to its fledgling Merit-based Incentive Payment System (MIPS) for physicians, while also pressing for the creation of a targeted reimbursement metrics that both the federal healthcare giant and private insurers would use. The study was published in New England Journal Of Medicine.
The Centers for Medicare & Medicaid Services (CMS), offered proposals to aid physicians who face a daunting challenge in adapting to MIPS, even as some health care policy experts lambaste the design of the program.This month, the influential Medicare Payment Advisory Commission (MedPAC), which Wilensky chaired from 1997 to 2001,
They will send Congress a formal recommendation to scrap MIPS and start over with a new approach to Medicare physician pay. This MedPAC recommendation comes as many physician’s struggles with rafts of competing metrics demanded by private insurers, Wilensky observes.
"The proliferation of quality measures is imposing substantial burdens on clinicians, and many of these measures are regarded as poor proxies for quality or as not reflecting what is important to patients," writes Wilensky, who is also a senior fellow at Project HOPE.
CMS should work with representatives of commercial insurers and groups representing clinicians and consumers to develop "a small set of metrics that better reflect outcomes and that matter to patients," she writes. In this study, the pending 2018 midterm election and the sharply divided Senate make it unlikely that Congress could soon pass another significant health law.
Wilensky also urges CMS to use its existing in-house resources to advance MedPAC's idea, an approach Redberg applauded. CMS could use its Center for Medicare & Medicaid Innovation (CMMI) to test MedPAC's proposal, Wilensky writes. The center, created as part of the 2010 Affordable Care Act, has authority to test different approaches for improving the delivery of healthcare.
MedPAC's proposal calls for a 2% withholding of Medicare fee-for-service payments. They could participate in an advanced alternative payment system (APM), which would require that they accept financial risk, or join a real or virtual group that would be evaluated by population-level measures, such as readmission rates.
A CMMI "pilot program would provide real-world evidence as to whether this strategy is an improvement over the MIPS regarding helping clinicians improve their practice and helping beneficiaries identify the healthcare organizations that offer better outcomes for their needs," Wilensky writes.
The author suggests that CMMI test a primary care APM that has been proposed by the American Academy of Family Physicians. Large medical trade groups, including the American Hospital Association, have asked that CMS revise MIPS but not end it.
The American Medical Association would like Congress to allow CMS to slow down the full phase-in of MIPS in 2019, Wilensky notes. In closing her article, she calls on physicians to reach out to their professional associations and lawmakers to reshape rules of quality metrics.