MedPAC’s Mic Is on MIPS and APMs

At the October Medicare Payment Advisory Commission (MedPAC) meeting, the Commission held its first discussion on the Alternative Payment Models (APMs) and the Merit-based Incentive Payment System (MIPS) introduced by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA repealed the sustainable growth rate (SGR) formula for determining Medicare payments for clinicians’ services, established a new framework for rewarding clinicians for value over volume, and streamlined other existing quality-reporting programs.

The presentation by MedPAC staff focused on the two payment paths for providers introduced through MACRA—APMs and MIPS—with an emphasis on the challenges of the APM program. The legislation provides what, on the surface, appears to be greater incentives for providers to participate on the APM path rather than the MIPS path; however, much remains to be decided by CMS. The commissioners’ lively discussion on the policy goals and challenges included debate about the difficulty associated with determining what spending an APM provider is responsible for, how beneficiaries are attributed, and how quality is incorporated so participation alone is not the marker of success.

The conversation was one part educational, one part solution-oriented, with commissioners looking to build on lessons learned in past efforts, including the SGR. Concern was raised about the incentives of APM participation and whether they would encourage care coordination and high-value/low-cost care. Additional questions were broached and postponed for further discussion, including the role of drug spending in tracking costs.

The Commission acknowledged this is just the first of many discussions on this topic but also noted the group has been having these parallel discussions for a number of years. The goal of the payment programs remains a little unclear other than replacing the SGR. CMS recently released a request for information (RFI) on MIPS and APM, which is expected to feed into proposed rules expected early next year.


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