January 18, 2018

MedPAC Votes to Recommend Elimination of MIPS

On Jan. 11, the Medicare Payment Advisory Commission (MedPAC) voted to recommend that Congress eliminate the Merit-based Incentive Payment System (MIPS) and establish a new voluntary value program (VVP) to reward quality within the current fee-for-service Medicare program.

MedPAC’s support for a proposed voluntary value program (VVP) reflects its belief that much of the information reported under MIPS is not meaningful and that scoring clinicians on different levels of effort is not equitable. The new program would allow clinicians to elect to be measured as a part of a voluntary group where they would be eligible to qualify for a value payment based on their group’s performance on a set of population-based measures.

MedPAC also voted to approve recommendations that Congress increase the calendar year 2019 Medicare payment rates for physicians and other health professional services by the amount specified in current law and that Congress raise the payment rate for acute care hospitals by 1.25 percent, an increase that would represent no change in spending relative to current law.

In addition to the MIPS program discussion, MedPAC commissioners held a session on “Rebalancing the physician fee schedule towards ambulatory evaluation and management (E&M) services.” MedPAC staff presented two options to address underpricing of E&M services relative to other services.

The first option is to increase payment rates for E&M and psychiatric services by 10 percent for all clinicians. To maintain budget neutrality with this option, payment rates for all other services would be reduced by 4.5 percent.

The second option is a special payment for primary care clinicians. An example of how this could be implemented is a 10 percent add-on for eligible services billed by primary care clinicians who derive at least 60 percent of payments from eligible services. Questions remain on how eligibility would be defined and determined, as well as how the options would be funded.

The commissioners discussed the two options presented by the staff and suggested their own alternative ideas for E&M fee balancing, such as separate conversion factors based on CPT code and medical school debt reduction incentives for primary care specialties.

Overall, the commissioners did not believe the two options presented by staff would solve the income disparity issue. No voting took place, and the commission will continue discussions on this topic at future MedPAC meetings.