CMS in the past was on a value-based binge. They aimed to reward physicians based on quality of care (PQRS), based on cost (a component in the value modifier), based on use of EHR (meaningful use bonuses). However, this imposed a large reporting bonus on physicians, pulling them away from patient care. To solve the problem, CMS implemented Merit-based Incentive Payment System (MIPS) to consolidate all these value-based reimbursement schemes into one.
Will this new system work? After reviewing the program, MedPAC was skeptical of MIPS:
MIPS, as designed, is unlikely to clearly identify highvalue or low-value clinicians and hence may be of limited utility for beneficiaries (in selecting high-value clinicians), for clinicians themselves (in understanding their performance and what to do to improve), or for the Medicare program (in adjusting payments based on value)
Specifically, they cite the low reliability of measures due to small patient counts for most measures for any individual physician; the fact that since physicians can select their own measures, comparing across physicians is difficult; budget neutrality rules mean that some physicians could get very high or very low bonus payments in the future.
One paper by Joynt Maddox (2017) looks at participation in MIPS based on previous data found that:
5.0 percent of the 899 practices would have received a performance-based bonus and 7.7 percent a performance-based penalty
Thus, the vast majority of practices would receive no bonus or penalty in practice.
Measuring quality of care is a good thing. Imposing significant reporting requirements on physicians is not. Thus, identifying a way to measure and pay for quality is valuable but the data collection burden and overall reliability must be increased to be able to do this. Another approach–balance billing–would allow high-quality physicians to charge more to Medicare patients, where quality would be defined not by bureaucrats, but by the consumers and patients actually receiving this care. Letting the market work, just might work.