The AMA is urging the new administration to reduce or eliminate some of the regulatory burdens and pain points in reporting requirements that drive physician burnout and complicate patient care without improving outcomes, part of sweeping reforms the AMA has championed in our decade-long push to reduce hassles for physicians and remove obstacles to care.
Practicing medicine today has become increasingly difficult amid a maze of federal regulatory policies and programs that may have been well-intentioned but have failed to improve care or cut costs. Instead, these regulations trigger a litany of unintended consequences that detract from patient care while burying physicians in paperwork and other administrative burdens.
One such program is the Merit-based Incentive Payment System (MIPS), which was launched almost a decade ago to adjust physicians’ Medicare payment rates based on their work to improve clinical practice and quality of patient care, utilize health information technology and control federal spending on medical care. Sadly, that goal has not been met, nor will it be going forward. In recent correspondence (PDF) with the Office of Management and Budget, the AMA explained that MIPS and a host of other rules have so far failed to demonstrate any meaningful improvement in patient outcomes, stifled competition, and resulted in no significant reductions in spending.
Reforming MIPS and other policies, such as the onerous prior authorization process, that are overburdening physicians and harming patients are essential components of the AMA’s federal advocacy work. The AMA is working to create a more efficient health system that better supports physicians, freeing us to deliver the very best care to our patients.
Plenty of burden, sparse benefit
While the AMA has long championed the transition to a value-based care model, the current MIPS process imposes significant costs on physician practices that struggle to comply with its extensive documentation and reporting requirements, and the frequent changes in its criteria. A JAMA Health Forum study published four years ago showed that MIPS compliance extracted an annual per-physician cost of almost $13,000 along with a time commitment of more than 200 hours.
More recently, figures compiled by the Centers for Medicare & Medicaid Services (CMS) pegged the overall burden of MIPS reporting compliance at a staggering $70.1 million and close to 600,000 hours. MIPS participation weighs most heavily on small physician practices as well as those serving patients in rural areas, which typically lack the staffing, technology and financial resources needed to manage its overly burdensome requirements.
Want the latest viewpoints from AMA leadership?
A better path forward
As part of the AMA’s overall effort to fix the unsustainable Medicare physician payment system, which remains a top advocacy priority, we and our partners in the Federation of Medicine have developed a replacement for MIPS called the Data-Driven Performance Payment System (DPPS).
This new approach focuses on reducing the regulatory burden placed on physicians by streamlining performance measures, eliminating arbitrary scoring rules that drive compliance costs higher, and ensuring that every aspect of the program reflects the realities of clinical practice by measuring the aspects of health care that truly matter to patients and physicians. The goal is to move away from a methodology based on a punitive and highly arbitrary scoring system in favor of a clinically relevant, data-driven approach that emphasizes timeliness and transparency.
Timeliness of data availability is a key factor here. Physicians participating in MIPS require access to a broad range of data to measure gaps in care, identify opportunities to improve patient outcomes, and eliminate avoidable services, among other needs. CMS has fallen short in this regard, as the agency’s annual MIPS Feedback Report to physicians offers data on their performance under MIPS metrics anywhere from six to 18 months after they have provided the care being measured.
As a result, physicians have no real-time visibility into cost performance measures that comprise 30% of their total MIPS score. It is easy to see why so many physicians believe that MIPS places entirely too much emphasis on penalties for poor scores or noncompliance.
To address this issue, the DPPS would shield physicians from negative payment adjustments unless CMS provides them with at least three quarterly performance feedback reports during a given year. Sharing this data, as well as Medicare claims data, with physician practices is essential to improving the quality of care provided and reducing costs; physicians should not be penalized if CMS cannot provide actionable data on a timely basis.
Additional reform opportunities
The AMA also supports lifting restrictions on physician-owned hospitals to foster greater competition, particularly in areas with high levels of hospital market concentration and in high-need Medicaid communities. We are working to encourage broader physician participation in Medicare Alternative Payment Models through lowering the financial risk threshold while promoting innovating care delivery and payment arrangements.
And the AMA supports refining the independent dispute-resolution process (PDF) under the No Surprises Act by relaxing batching restrictions and reducing the cooling-off period to ease the burden on physician practices.
And of course, fixing the onerous and inefficient prior authorization process that health plans and benefit managers use to control their costs—while harming patients and burdening physicians in the process—needs to happen now.
As the physician’s powerful ally in patient care, the AMA will never relent in our drive to identify and remove bureaucratic hurdles that interfere with our primary purpose: helping patients. This fight will not be easy, but achieving any worthwhile goal seldom is. I invite you to join us in our drive to forge a better health care system and a healthier nation.
