MIPS: It’s time to get started


David O. Barbe, MD, is urging physicians to participate in the Medicare Quality Payment Program, even if the business case isn’t quite there.

QPP is the value-based payment system created by the Medicare Access and CHIP Reauthorization Act (MACRA). It promotes high-value care through Medicare payment increases. But for some practices, the investment in personnel and technology needed to earn those increases may be more than the increases themselves, leading doctors to do just enough to avoid being penalized.

“I think that many physicians don’t feel they are ever going to get a bonus but sure would like to avoid a penalty,” Dr. Barbe, president of the American Medical Association, said in an exclusive interview. “I am afraid many will simply perform at the lowest level that keeps them out of the penalty. Because many of them find that making the investment it takes to perform highly, there is not a business case for that.”

Full participation in QPP’s Merit-based Incentive Payment System (MIPS) could run small practices an additional $10,000 to $30,000 a year, he said. “If you’ve got $200,000 in Medicare receipts, if you get adjusted even the maximum of 4%, that is $8,000. You can’t cover $20,000 with $8,000. The math doesn’t work. There is not a business case there for it.”

That said, Dr. Barbe still spoke in favor of QPP and noted that the AMA is working with the Centers for Medicare & Medicaid Services as well as Congress to make the program more valuable and meaningful for physicians.

“We understand where we need to go as a profession, as an industry,” he said. “How we get there is the key, it’s the challenge and it requires flexibility. ... CMS has been accommodating but there are limits to how long they can go.”

The AMA is urging doctors who have missed the 90-day window for full participation – which effectively closed for most on Oct. 2 – to consider the Pick Your Pace option offered by the CMS.

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Pick Your Pace allows physicians and practices to submit data on one measure for one patient to avoid a reduction in Medicare pay, even though they would not be eligible for a bonus.

“AMA has put out a lot of tools to help physicians assess their readiness, assess the gap between what they are able to do in their practice now and what they need to do to be successful under [the MIPS] primarily down to and including a video that would walk a physician step-by-step through the one patient, one measure, no penalty,” Dr. Barbe said.

He also encouraged doctors to pick a measure that is meaningful to their practice if only to get the ball rolling and get their feet wet in the QPP pool.

“What I tell physicians is pick something that is relevant for your practice,” he said.”If I see a lot of diabetes patients in my practice but I don’t see many people on anticoagulants, it doesn’t make sense for me to pick an anticoagulant measure.”

And if all a practice can do this year is one patient, one measure, Dr. Barbe urged physicians to look toward the next reporting year with an eye to do more, as that will ultimately lead to better quality of care delivered.

“Report on one patient and one measure this year ... but look at next year to say ‘that’s going to be a 90-day project for me,’ and get in on that. There is a pretty long laundry list of conditions and metrics that you can report on.”

And if practices start capturing relevant data, it opens the door to improving their practice if they also take the time to analyze what they are collecting.

“That is the purpose,” Dr. Barbe said. “As you measure yourself along the way, if the threshold for performance is here, and you find yourself working at this [lower] level for the first 30 days or whatever, then you stop and take stock of that” and react accordingly, whether its providing patients with a little more information about their condition or perhaps being more diligent in terms of monitoring high risk patients.

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