AMA, AAFP, and other stakeholder associations advocated for lawmakers to simplify MACRA and eliminate MIPS health IT utilization measures.
In testimony before the Senate Committee on Finance, AMA, AAFP, and AMGA voiced their support for the shift to value-based care and the Merit Based Incentive Payment System, but urged policymakers to simplify the program by eliminating some health IT utilization measures and instead focusing on outcomes-based measures.
While stakeholders feel MIPS can be improved, most commended several aspects of the program and expressed overall support for Congress’ decision to abandon the fee-for-service payment model.
In written testimony, AMA President Barbara McAneny, MD, applauded CMS for making efforts to ensure small practices can participate in MIPS.
“AMA appreciates the accommodations for small practices that are included MIPS. Specifically, the low-volume threshold exemption excludes numerous small practices or physicians who see very few Medicare patients,” said McAneny. “In 2018, physicians with annual Medicare allowed charges of $90,000 or less or 200 or fewer Medicare patients were exempt from the QPP altogether.”
“AMA has also supported reduced reporting requirements for small practices, hardship exemptions from the Promoting Interoperability MIPS performance category for qualifying small practices, bonus points for small practices, and technical assistance grants to help small and rural practices succeed in the program,” McAneny continued.
While these policies make reporting requirements easier on small and rural practices, AMA is still concerned about certain policies that inhibit these providers from succeeding in the program.
“In 2017, the national mean and median scores for all MIPS eligible clinicians were 74.01 and 88.97 points. However, the mean and median scores for rural and small practices were 43.46 and 37.67, and 63.08 and 75.29, respectively,” said McAneny.
“Given the lower scores achieved by small and rural practices compared to all MIPS eligible clinicians, the AMA urges Congress and CMS to continue to implement policies that help small and rural physician practices succeed in MIPS,” she added.
McAneny also recommended Congress make additional technical changes to MACRA to simplify reporting and ensure the program is more clinically meaningful for clinicians.
“We continue to hear from physicians that the program needs to be streamlined and more clinically relevant,” she maintained.
“For example, Congress and CMS can make MIPS more cohesive and meaningful to physicians and patients by allowing physicians to focus their participation around a specific procedure, condition, or public health priority,” McAneny explained.
By allowing physicians to focus on activities that fit within their workflow and address their patient population needs, rather than focusing on segregated activities that fit into the four disparate MIPS categories, the program could improve the quality of care and be more meaningful and less burdensome for physicians. The AMA has worked closely with the physician community to develop a streamlined MIPS participation option that would hold physicians accountable for the cost 6 and quality of care around a specific episode.
AMA also recommended Congress update the Promoting Interoperability performance category to allow physicians to use certified EHR technology in more clinically relevant ways and develop a separate threshold for small and rural practices to ensure all physicians participating in MIPS do so on an even playing field.
The association also recommended policymakers incentivize reporting on new quality measures, especially those geared toward specialties.
For its part, AAFP recommended lawmakers reduce the scoring complexity within MIPS.
“The implementation of MIPS has created a burdensome and extremely complex program,” stated AAFP President John Cullen, MD.
“However, understanding the requirements and scoring for each performance category and reporting data to CMS is a complex task and detracts from primary care practices’ ability to focus on patients,” Cullen added.
Cullen testified that MIPS cost category measures are flawed and overly strict on primary care physicians compared to clinicians in other sub-specialties.
“We urge Congress to extend CMS’s authority to weigh the MIPS cost category below 30% to allow time to overhaul existing measures,” said Cullen.
AAFP members also expressed concern over the PI performance category within MIPS.
“CMS is hamstrung in PI since the agency is bound to Meaningful Use requirements by legislation, including both the American Recovery and Reinvestment Act and the Affordable Care Act,” stated Cullen. “The AAFP calls on Congress to repeal Meaningful Use requirements and allow HHS to remove these requirements from the PI category.”
Specifically, AAFP takes issue with the “all or nothing” nature of the category, Cullen testified.
“Failure to report one measure results in a category score of zero. For all intents and purposes, this is an ‘all or nothing’ structure,” he said.
Cullen also recommended CMS eliminate health IT utilization measures, as well as any required measures. Instead, Cullen suggested clinicians be given the flexibility to choose measures relevant to their practice.
“All measures within the promoting interoperability category should be attestation-based,” Cullen added.
American Medical Group Association Director Scott Hines, MD, stated his support for Congress’ goals in implementing MIPS but noted that CMS has excluded nearly half of eligible clinicians from MIPS requirements.
“Because MIPS is budget neutral, these exclusions result in insignificant payment adjustments to high-performing providers,” said Hines.
“By excluding half of providers from MIPS, the system has devolved into an expensive regulatory compliance exercise with little impact on quality or cost,” Hines added.
To improve reimbursement rates, Hines recommended Congress no longer exclude providers from participating in MIPS.
With these recommended changes, stakeholder associations hope to push the healthcare industry further toward its goal of realizing a value-based care system.
Date: May 09, 2019
Source: EHR Intelligence