CMS suggests demonstration to waive MIPS rules for clinicians

The Centers for Medicare and Medicaid Services wants to launch a demonstration to test the concept of waiving Merit-Based Incentive Payment System requirements for clinicians who participate in certain Medicare Advantage plans that involve taking on risk.

Under the Quality Payment Program created by the Medicare Access and CHIP Reauthorization Act, clinicians currently participate in the QPP through one of two ways: the Merit-Based Incentive Payment System (MIPS), which adjusts Medicare payments based on combined performance on measures of quality, cost, improvement activities; and advancing care information; or Advanced Alternate Payment Models (APMs), which require clinicians to take on risk for what is spent for their patients’ healthcare.

According to CMS, some Medicare Advantage plans are developing innovative arrangements that resemble Advanced APMs. However, without undertaking the agency’s proposed Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) demonstration—which is under consideration for formal approval—physicians are still subject to MIPS even if they participate extensively in Advanced APM-like arrangements under Medicare Advantage.

Verma-Seema-CROP.jpg
Seema Verma, Centers for Medicare and Medicaid Services administrator nominee for U.S. President Donald Trump, speaks during a Senate Finance Committee confirmation hearing in Washington, D.C., U.S., on Thursday, Feb. 16, 2017. Verma, the businesswoman Trump selected to oversee Medicaid, the health care program for 74 million low-income Americans, has said the program is structurally flawed by policies that burden states and foster dependency among the poor. Photographer: Pete Marovich/Bloomberg

“The MAQI demonstration aligns with the agency’s goal of moving to a value-based healthcare system, and aims to put Medicare Advantage on a more equal playing field with Fee-for-Service Medicare,” said CMS Administrator Seema Verma in a written statement. “CMS intends to test whether MIPS exemptions provided to clinicians under MAQI will increase participation in Medicare Advantage plans that are similar to Advanced APMs, and thereby accelerate the transition to a healthcare system that pays for value and outcomes.”

MIPS has an advancing care information (ACI) performance category with measures that support clinical effectiveness, information security and patient safety, patient engagement, as well as health information exchange. In late May, CMS announced that 91 percent of all clinicians eligible for MIPS participated in QPP’s inaugural year—slightly exceeding the agency’s goal of 90 percent participation.

Also See: CMS Quality Payment Program exceeds first year participation goal

The first performance period for the proposed MAQI demonstration is tentatively planned for 2018, and it would last as long as five years, according to a notice to be published on Tuesday in the Federal Register. Clinicians who meet the definition of MIPS eligible clinician under QPP—including physicians, physician assistants, nurse practitioners, clinical nurse specialists and certified registered nurse anesthetists—would be eligible to participate in the demonstration.

CMS will be accepting public comments for 60 days on the estimated information collection burden associated with its proposed demonstration.

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