Why Medicare overhaul must include fixes for burdensome MIPS effort

AMA News Wire

Why Medicare overhaul must include fixes for burdensome MIPS effort

Jun 28, 2023

Although the Medicare Merit-based Incentive Payment System (MIPS) is well-intentioned, its reporting requirements are burdensome to physician practices and often appear to be clinically irrelevant and more focused on checking boxes rather than improving care.

MIPS grew out of the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, which promised to create a path to a value-based health care system that would reward physicians more for the successful patient outcomes they helped achieve rather than for the volume of the clinical tasks they completed.

Along with revising MIPS to make it more clinically relevant and less burdensome, the AMA strategy for Medicare payment reform involves:

• Linking automatic inflation-based annual updates to the Medicare Economic Index.
• Revising the Medicare physician pay schedule’s budget neutrality requirements and triggers.
• Making more alternative payment models (APMs) available for practices to participate in.

The evidence is clear: The Medicare payment system is on an unsustainable path threatening patient access to physicians.

Leading the charge to reform Medicare pay is a critical component 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.

To help physician advocates and lawmakers get a stronger grasp on the complicated terrain of Medicare physician payment reform, the AMA has developed a series of explainers that outline problems with the issues mentioned above and offer solutions:

• Medicare physician payment adequacy: Budget neutrality (PDF).
• The Medicare Economic Index (PDF).
• Merit-based Incentive Payment System (MIPS) (PDF).
• Advancing value-based care with alternative payment models (PDF).

The one- to three-page explainers offer straightforward explanations for policymakers and physician advocates about these elements of the payment system and why reforms are needed.

“Evidence of the shortcomings of MIPS continues to pile up,” notes the MIPS explainer. The AMA cites research from JAMA Network™ journals and others showing that MIPS:

• Scores are inconsistently related to performance, and physicians caring for more patients from historically marginalized racial and ethnic groups were more likely to receive low scores despite providing high-quality care.
• Compliance costs $12,800 per physician per year, and physicians spend 53 hours per year on MIPS-related tasks—the equivalent of a full week of patient visits.
• Exacerbates health inequities. In the first year of MIPS, physicians with the highest proportion of patients dually eligible for Medicare and Medicaid had significantly lower MIPS scores compared with other physicians.
• Hurts independent practices as MIPS-eligible physicians affiliated with better-resourced health systems were associated with significantly better MIPS performance scores.

In addition, current law calls for 0% payment update for MIPS-eligible physicians through 2025 and penalties of up to -9%.

The MIPS explainer notes that CMS has tried to improve the program, but these changes “are superficial as the agency is hamstrung by its lack of statutory authority to remedy these problems directly.”

The AMA is calling for congressional action to:

• Prevent unsustainable penalties, particularly for small practices and those in rural and communities that have been economically or socially marginalized.
• Invest in and enable the move to value-based care.
• Increase MIPS transparency and oversight.

The AMA—in collaboration with 120 other physician and health care organizations—has outlined the essential principles (PDF), including an annual inflationary update, that can put the nation’s health care system on sustainable financial ground.

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.