Lack of timely MIPS data hobbles doctors’ value-based care efforts

Kevin B. O'Reilly , News Editor

AMA News Wire

Lack of timely MIPS data hobbles doctors’ value-based care efforts

Sep 21, 2023

What’s the news: As part of its campaign to fix the unsustainable Medicare physician payment system, the AMA is outlining in a quick, easily navigable fashion the need to give doctors access to a wide range of timely information to identify opportunities to improve health outcomes, reduce variations in care delivery or eliminate avoidable services—all steps that can lower costs for patients and the Medicare program.

Speak up for Medicare reform

The need for Medicare physician payment reform has never been greater. The AMA shows how the current system is unsustainable—and how you can urge Congress to support solutions.

To be successful in advancing value-based care, physicians in Medicare’s Merit-based Incentive Payment System (MIPS) need timely access to that kind of data. While Congress recognized the critical importance of data sharing with physicians in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) statute that created MIPS by requiring timely performance feedback, the Centers for Medicare & Medicaid Services (CMS) has dragged its feet in meeting this statutory obligation.

Check your MIPS feedback score today

Physicians have till Oct. 9 to check their MIPS feedback score and file an appeal if needed to avoid penalties affecting their payment for Medicare services provided in 2024.

The agency has never provided Medicare claims data to physicians, even though the requirement took effect in 2018, notes the AMA’s two-page explainer on MIPS data problems (PDF).

To address these problems, the AMA is calling on Congress to:                                                                          

  • Direct CMS to improve timely access to MIPS feedback reports and claims data as required by MACRA.
  • Exempt from MIPS penalties any physician who does not receive at least three quarterly MIPS feedback reports during the performance period.

Learn about how you can take part in the fight to fix Medicare on behalf of your patients and practices at the AMA's Fix Medicare Now website.

Leading the charge to reform Medicare pay is the first pillar of the AMA Recovery Plan for America’s Physicians.

The AMA has challenged Congress to work on systemic reforms and make Medicare work better for you and your patients. Our work will continue, fighting tirelessly against future cuts—and against all barriers to patient care.

Related Coverage

Congress must act now on Medicare physician payment reform

Why it’s important: CMS does release an annual overview of data collected through its Medicare Quality Payment Program (QPP), including MIPS and alternative payment model data, and the number of physicians who will receive a MIPS bonus or penalty. But the data provided by this QPP Experience Report is of limited use, the AMA explains.

For example, the same physician can be counted multiple times if they bill for services through multiple organizations. And a physician can have a low MIPS score for one practice and a high MIPS score for another. On top of that, CMS does not break down performance by physician specialty, site of service, or the type of reporting.

The report also fails to show any longitudinal trends about whether quality or cost are getting better or worse, nor does it provide a complete picture of what made a physician or group practice successful in MIPS.

The AMA’s own analysis of several MIPS data files found that they are incomplete and inconsistent. As a result, it is difficult to drill down into the data to better understand how small practices and rural practices, for example, are performing in MIPS and why this might be the case. Meanwhile, a study published in JAMA®last year found that MIPS scores are inconsistently related to performance. Ensuring that data is accurate is critically important to ongoing efforts to understand and improve this program.

We need your help

Become a member and help the AMA fight to protect physician payment and patients’ access to care.

Learn more: In response to a request for comment about 12 MIPS cost measures that are being reevaluated, the AMA has strongly urged CMS to remove both the “Total Per Capita Cost” and “Medicare Spending Per Beneficiary” clinician measures from MIPS. These measures hold physicians accountable for costs they cannot influence, such as drug prices. A recent study found that oncologists scored poorly on both measures because they do not account for the cost variation by physician specialty in providing the standard of care. 

The AMA has declared Medicare physician payment reform to be an urgent advocacy and legislative priority. To help physician advocates and lawmakers get a stronger grasp on the complicated terrain of Medicare physician payment reform, the AMA has developed this series of additional explainers that outline problems offer solutions on:

Visit AMA Advocacy in Action to find out what’s at stake in reforming Medicare payment and other advocacy priorities the AMA is actively working on.