Remember that Peanuts cartoon of Lucy in the lemonade stand with the sign that read, “The Doctor is In”? The big question these days is whether doctors are IN or OUT of MIPS. The GOP Doctors’ Caucus members have asked CMS Administrator Seema Verma to cut back on the number of physicians excluded from the Merit Based Incentive Payment System (MIPS) in 2019. They are concerned because as the pool of participants gets smaller, the amount of money for bonuses decreases.
The 2019 Medicare Physician Fee Schedule rule should include updates to the Quality Payment Program (QPP), so they are hoping to impact the language of the proposed rule. In a July 3rd letter, GOP Doctors Caucus Co-Chairs Phil Roe (TN) and Andy Harris (MD), and members Reps. Buddy Carter (GA), Larry Bucshon (IN) and Scott DesJarlais (TN) asked that CMS make sure high performing providers have the chance to earn higher bonuses, originally scheduled to reach 7% in the 2019 performance year.
The letter points out that MIPS needs the maximum bonus under law if it is going to actually work. “Moving Medicare onto a path of long-term sustainability was the goal of MACRA, and meaningful provider participation is one of the best ways to ensure program viability into the future. Promoting the system of maximum adjustments in a timely manner will ensure provider participation as well as the best possible care for our nation’s seniors.”
CMS allowed doctors to “pick their pace” in 2017 and then expanded exclusions in 2018. As a result, high performers are estimated to receive an aggregate bonus of only 1.1% of their Part B Medicare payments in 2019 (based on their 2017 performance), even though the law allowed up to a 4% bonus. The result is that there’s little incentive to participate. For all the flaws of the program, Congress passed MACRA with the goal of reforming Medicare so that it paid for value, a transition which can’t occur if a substantial portion of physicians are not required to participate.