A new government watchdog report offers more doubt about the effectiveness of a heavily criticized Medicare provider payment program.
The Merit-based Incentive Payment System scores physicians and other providers based on quality and cost measures and uses those scores to adjust future Medicare payments.
MIPS lets providers cherry-pick the measures they report and doesn’t yield enough of a payoff to be worth participating in, said most stakeholders the Government Accountability Office interviewed for an analysis.
MIPS is mandatory unless providers quality for an exemption, such as having $90,000 or less in annual charges under Medicare Part B.
The overwhelming majority of providers that participate in MIPS earn money as opposed to being penalized. Of the 1 million clinicians who participated in MIPS first year in 2017, 93% received bonuses starting in 2019. Roughly 5% received a penalty as high as 4%.
A common complaint is that those financial rewards are too small. The largest Medicare payment adjustment was about 1.9% between 2017 and 2019. Eight out of 11 stakeholder groups told the AGO the positive adjustments didn’t cover the administrative cost of complying with the program.
The GAO report includes the hypothetical example of a well-performing practice with $100,000 in Part B payments that received less than $2,000 in enhanced payments, yet spent $10,000 to get MIPS-specific reports from its electronic health records vendor to participate.
The stakeholder groups also questioned whether MIPS helps with quality or patient outcomes. Providers can maximize their upward adjustments by picking performance measures they’re doing well on and ignoring those on which they performed poorly. Providers might perform unnecessary screenings to meet quality measures.
From Modern Healthcare Daily Dose of October 5, 2021