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    MIPS: The ‘death knell’ for small practices?

    Beginning in 2019, the new Merit-based Incentive Payment System (MIPS), which is part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), will raise the focus on physician performance measurement to a new level.
    Robert A. Berenson, MD, a fellow at the Urban Institute in Washington, DC, recently authored an article in JAMA Forum critical of the legislation’s focus on doctors’ performance on what he calls a few, random, unreliable measures that he says give a misleading view of a physician’s work.
    A board-certified internist who practiced for 20 years before pursuing a health policy career, Berenson is one of the nation’s best-known health policy experts. He has served on the Medicare Payment Advisory Commission, has headed up Medicare payment policy and private health plan contracting in the Centers for Medicare & Medicaid Services (CMS), and served as an assistant director of the White House Domestic Policy Staff under President Carter.

    The uncertain future of Meaningful Use
    MIPS will replace the Physician Quality Reporting System (PQRS) and CMS will adjust Medicare payments to most physicians either up or down by as much as 9% depending on how well they score in four performance categories: quality, resource use, clinical practice improvement activities, and meaningful use of electronic health records systems. Also, physicians who score extremely high will be eligible for a 27% payment bonus.
    In the interview below, Berenson elaborates on his views regarding MIPS.

    Medical Economics:
    Q: You’ve been critical of the measurement approach that CMS and other payers have adopted, and you focus in particular on MIPS. Are you concerned that MIPS will have some unintended consequences, and, if so, what concerns you most?

    A: We lack measures that are core to what is central to the performance we expect from particular specialists. I also have concerns that the approach may compromise physicians’ intrinsic motivation to practice high-quality care for their patients as they respond to specific incentives for particular aspects of performance.

    Healthcare (finally) takes center stage for 2016 Republican nomineesWith MIPS, Congress is combining PQRS, Meaningful Use and the value-based modifier. Those were three separate programs that were going to add up to a little more than 2% of a physician’s Medicare payment. But the penalties under MIPS now add up to 9%, with potential gains of 27% for some lucky physicians. They’ve created a whole new formula for how you get either rewards or penalties.

    Next: What about small practices?

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    • Anonymous
      Reporting quality measures is costly, not useful for physician practices, survey finds Written by Heather Punke (Twitter | Google+) | March 07, 2016 3 inShare Reporting on quality metrics is a time-consuming task for physicians and their staff. U.S. physician practices in four common specialties spend, on average, 785 hours per physician each year on reporting quality measures. Overall, that time costs practices an estimated $15.4 billion each year, according to a survey in Health Affairs. Researchers surveyed 395 orthopedic, primary care, cardiology and multispecialty physician practices that are members of the Medical Group Management Association. Survey questions asked for details of time spent on activities related to reporting and inspecting quality data, as well as practice leaders' perception on how useful those measures are. One troubling finding is the most time — 12.5 hours of physician and staff time per physician per week — was spent on entering information into the medical record for the sole purpose of reporting for quality measures from external entities. Sign up for our FREE E-Weekly for more coverage like this sent to your inbox! Additionally, 81 percent of practices reported their effort in reporting on quality measures is increasing compared to three years ago, and 46 percent called it a significant burden to deal with similar, but different, quality measures. For instance, the study authors noted the Medicare Shared Savings Program metric for poor diabetes control is a hemoglobin A1c at or below 8 percent, while the Healthcare Effectiveness Data and Information Set puts the level at or below 9 percent. Even though physician practices are putting a lot of time and effort into reporting on quality metrics, most of them aren't using the information to improve quality. The survey found that just 28 percent of surveyed practices used the quality scores to focus quality improvement activities, and just 27 percent said current measures were moderately or strongly representative of the quality of care. "There is much to gain from quality measurement, but the current system is far from being efficient and contributes to negative physician attitudes toward quality measures," the authors wrote. They noted that rapid improvements to the system will be difficult to make, but urged focus on the area. "Our data suggest that U.S. healthcare leaders should make these efforts a priority." Halee Fischer-Wright, MD, president and CEO of MGMA, said in a statement, "This study proves that the current top-down approach has failed. It serves no purpose to have over 3,000 competing measures of quality across government and private initiatives. Although standardization is critical, if measures don't improve patient care, it's an exercise in futility. As the largest contributor to the problem, the federal government needs to get out of the business of dictating patient care through wasteful mandates and create simplified systems to support medical practices in improving quality across the country." Note: A previous version of this article stated quality reporting costs $14.5 billion annually. The real cost is $15.4 billion. We regret this error.
    • Anonymous
      What planet is Dr Berenson living on?? He served on the Medicare PAC & basically ran CMS and he can't figure out why Congress passed another terrible law? Think about it! Fifty percent don't participate and >50 % of the remaining physicians can't comply! That's a lot of $$$$ in the coffer for CMS ( or Congress) while our stupid little businesses continue to serve til " last man down"! Wake up American physician and go independent!
    • Anonymous
      Thanks for the good news, lets see, the typical 30 minute appointment now went down a few more minutes. 5 minutes to talk and examine the patient 15 minutes to document the visit in the EMR having the patient watch you type, some times I let the kids type their own notes, they type fasting than me 5 minutes to figure out if they need a referral or drug authorization 5 minutes to pick a PQRS code that fits The 15 minute follow up appointment is going to be in negative territory , unless I skip the first part, talking to the patient and examination.

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