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News & Press: Government Affairs News

MedPAC Publishes Recommendation for Program to Replace MIPS

Saturday, March 17, 2018   (0 Comments)
Posted by: Bradley Coffey, MA, AAOE Government Affairs
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Washington, DC - The Medicare Payment Advisory Commission (MedPAC) published its annual report to Congress on Medicare payment policy this week. In the highly anticipated report, the Commission published its recommendations to get rid of the Merit-based Incentive Payment System (MIPS) and replace it with the "Voluntary Value Program".

Why it Matters: The Merit-based Incentive Payment System has only been around for two years giving it little time to take root within Medicare's reimbursement policies. MedPAC writes that the very design of the program dooms it to failure and makes provider comparison difficult.

Healthcare groups have been pushing Congress and the Centers for Medicare and Medicaid Services (CMS) to make changes to the program since Congress' passage of the Medicare Access and CHIP Reauthorization Act of 2015 which created the MIPS program.

Replacement far From Voluntary: While not contained in MedPAC's final report, discussion among Commissioners has included across the board cuts of up to 7% of physician reimbursements to fund the program. Those cuts would then be funneled back to physicians participating in the program while those that do not participate lose the money.

Under MIPS, physician reimbursements are not affected until a year following submission of reporting documentation. Those that participate, have a chance to receive a positive payment adjustment plus an exceptional performance bonus. Those that opt not to participate or perform below the performance threshold will see their payments cut.

New Program Would Funnel Physicians Into A-APMs: MedPAC believes that transformative, value-based care will only happen in Advanced Alternative Payment Models and sees the new program as a stepping stone between fee-for-service and value-based reimbursement.

One of the concerns with MedPAC's enthusiasm for A-APMs is that there are simply not enough A-APMs that contain orthopaedic and subspecialty clinical episodes. CJR and BPCI Advanced both contain orthopaedic clinical episodes. However, these models are still in the demonstration model phase of development and will end after a set number of years. If CMS decides not to fully implement these models, orthopaedists would be out of an A-APM and back in fee-for-service.

Outlook: Don't expect this to become law under the current Congress. MedPAC does not have any policy-making powers and can only recommend policy changes to Congress. With Republicans in charge and the GOP Doctors Caucus having fought hard to create MIPS, it's unlikely that House and Senate Leadership will want to anger such an influential group of lawmakers.

Even under future congress' it's difficult to see this becoming policy either under Democratic or Republican control.


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