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This is an update on the December 11, 2017 blog “Most Physicians Not Prepared for Value-based Care Transition

The Merit-based Incentive Payment System (MIPS), which came into effect in January 2017 was designed to tie payments to quality and cost-efficient care, drive improvement in care processes and health outcomes, increase the use of healthcare information, and reduce the cost of care, says CMS. However, even in its second year, physicians are confused with this payment system, as a recent study published in Health Affairs found. This survey of internal medicine physicians, published by the University of Pennsylvania scholars has found that 60 percent of physicians reported being not at all or only slightly familiar with MACRA and its requirements, and only 8 percent reported being very familiar. As one of the experienced medical coding companies in USA, we understand that accurate medical billing and coding is critical for claim submission in both Merit-based Incentive Payment System (MIPS) and Advanced Alternate Payment Models (APMs).

MIPS

MIPS also replace three previous programs, including Medicare Electronic Health Records (EHR) Incentive Program for Eligible Clinicians, Physician Quality Reporting System (PQRS), and the Value-Based Payment Modifier (VBM). In MIPS, performance is measured through the data clinicians report in four areas – Quality, Improvement Activities, Promoting Interoperability (formerly Advancing Care Information), and Cost. This latest survey was conducted to find out if physicians believed that their efforts in these four focus areas identified in the survey would ultimately improve the value of care.

Of the three survey sections of internal medicine physicians during March-May 2017, the first section evaluated respondents’ beliefs about the degree to which performance in the four focus areas is within physicians’ control and should be tied to their compensation. The second section reported their level of familiarity with MACRA requirements and they were asked how they believed MIPS as a policy would ultimately affect the value of patient care. In the third section of the survey, respondents were informed that under this payment system, physician payments will be adjusted based on a composite score derived from performance in the four domains.

It was found that the majority of respondents remained positive about the likely impact on value. Other key findings include the following.

  • Many doctors are worried that the pay-for-performance incentives could harm patient care
  • Those who own or run small practices are more aware of and sensitive to policy change than doctors who might work for a healthcare system
  • There is an immediate and urgent need to continue educating physicians about MIPS requirements
  • More than half of the respondents reported “some” or “a great deal” of willingness to change their behavior for the sake of value with respect to each of the four focus areas
  • Smaller proportions believed that at least some compensation should be tied to these focus areas (35 to 41 percent) and that physicians have at least some control over these areas (36 to 45 percent)
  • While most respondents believed that physicians’ efforts in these focus areas would “somewhat or significantly” improve the value of patient care, some physicians expressed the belief that such efforts would either reduce value or neither improve nor reduce it
  • It was also recommended that policy makers should monitor for unintended consequences and find ways to better align program guidelines with physicians’ perspectives

These survey findings indicate an immediate need to continue educating physicians about MIPS requirements.

In the 2019 Quality Payment Program recently released by the Centers for Medicare & Medicaid Services (CMS) last week, 10 new quality measures would likely be added to the MIPS program. It also includes several changes to the MIPS that aim to reduce administrative burden for eligible clinicians. The agency also proposed changes to the MIPS “promoting interoperability” performance category, which are designed to improve interoperability of electronic health record (EHR) data, giving patients easier access to their own health data, and aligning the performance category with a similar proposal for hospitals. Medical coding service providers should also be familiar with all such payment requirements and changes, to serve healthcare providers better.