With the enactment of the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, the Medicare Sustainable Growth Rate formula was repealed and replaced with the Quality Payment Program (QPP). Eligible clinicians can participate in the QPP via one of two pathways: the Merit-Based Incentive Payment System (MIPS) or Alternative Payment Models (APMs). Physician payment for Medicare being driven by MIPS and APMs began in 2019 with 2017 reporting. Proper and fair implementation of MACRA is a priority for ASGE. The Society continues to engage with the Centers for Medicare & Medicaid Services (CMS) as implementation of the QPP evolves, and ASGE will draw from two recently published qualitative studies looking at MIPS relative to time and cost to participate and physician leaders’ perceptions of the program.
Published in JAMA Health Forum in May 2021, Time and Financial Costs for Physician Practices to Participate in the Medicare Merit-based Incentive Payment System examines the costs for independent physician practices to participate in MIPS in 2019, recognizing the growing concern that MIPS increases administrative burden. The study found the mean per-physician cost to practices of participating in MIPS was $12,811, with physician time accounting for the greatest proportion of overall MIPS-related cost among the hours spent annually per physician by physicians, clinical staff, and administrative staff on MIPS-related activities.1
Published in the Journal of General Internal Medicine in April 2021, Physician Practice Leaders’ Perceptions of Medicare’s Merit-Based Incentive Payment System (MIPS) identifies major themes related to practice participation in MIPS. Six major themes emerged:
- MIPS is understood as a continuation of previous value-based payment programs and a precursor to future programs;
- measures are more relevant to primary care practices than other specialties;
- leaders are conflicted on whether the program improves patient care;
- MIPS creates a substantial administrative burden, exacerbated by annual programmatic changes;
- incentives are small relative to the effort needed to participate; and
- external support for participation can be helpful. Many participants indicated that their practice only participated in MIPS to avoid financial penalties; some reported that physicians cared for fewer patients due to the program’s administrative burden.2
The findings from these studies will be useful to ASGE as it discusses with policymakers improving MIPS so that more direct relationships to improved patient care can be realized while minimizing the administrative burden of the program. To read the articles in full select here.
To look up your MIPS eligibility status on CMS’ QPP website select here. All you need is your NPI and two minutes. Make sure you are checking your status for the 2021 performance year.
- Khullar D, Bond AM, O’Donnell EM, Qian Y, Gans DN, Casalino LP. Time and Financial Costs for Physician Practices to Participate in the Medicare Merit-based Incentive Payment System: A Qualitative Study. JAMA Health Forum. 2021;2(5):e210527. doi:10.1001/jamahealthforum.2021.0527
- Khullar D, Bond AM, Qian Y, O'Donnell E, Gans DN, Casalino LP. Physician Practice Leaders' Perceptions of Medicare's Merit-Based Incentive Payment System (MIPS). J Gen Intern Med. 2021 Apr 9:1–7. doi: 10.1007/s11606-021-06758-w. Epub ahead of print. PMID: 33835310; PMCID: PMC8034038.