The Medicare Payment Advisory Commission recently voted to replace the Merit-Based Incentive Payments System (MIPS), leaving many health care leaders questioning their current payment strategies. During our recent webinar “What’s Happening with MIPS? A Policy Update from Caravan Health”, senior vice president of strategy and development Tim Gronniger brought clarity around the proposed changes and discussed how hospitals can best position themselves for success with MIPS.

Gronniger shared that this January, MedPAC – a Medicare advisory body for congress – voted in their annual March report to eliminate the MIPS program and replace it with a new Voluntary Value Program (VVP).

In their recommendation, MedPAC expressed criticized MIPS for being excessively burdensome, encouraging measures that aren’t meaningful for patients, and not creating strong enough incentives to join alternative payment models like ACOs.

To overcome these challenges, MedPAC proposed the VVP replace MIPS with the following:

  • Withhold 2 percent of Medicare payments for providers not in APMs
  • Clinicians not joining the VPP forfeit the 2 percent withhold
  • Non-APM clinicians reclaim a portion of the withhold by participating in a voluntary group that would be measured on a set of population-based measures
  • Measures would be claims-based

Gronngier noted that the VVP has received less than favorable reactions from Congress, and that Commission members are also in disagreement over the proposal. The group expressed concerns that the option will encourage clinicians to remain in fee-for-service, the 2 percent margin won’t encourage behavior change, and that claims-based measures ignore case mix and socioeconomics.

While the MedPAC vote remains uncertain, Gronniger shared that Congress will most likely take action on other, much more limited modifications of the MIPS program.

Based on those proposed elements, Gronniger said that Medicare extenders will be added, as well as a “MACRA extender” package that provides limited additional authority for CMS to relax thresholds for now, and exclusion of Part B Drugs from MIPS adjustments.

No matter what the future holds for MIPS, Gronniger stands firm that ACO participation is the most favorable and sustainable payment strategy for hospitals. Congress has favored risk-bearing payment models for the long term, and participating in an ACO now will provide the easiest path to participating in a risk-bearing model in the future.

To learn more, watch the webinar.

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