Overnight Congressional Bill Proposes Slowing Down MIPS
A Congressional bill passed in the early morning hours on Feb. 9 brought an end to an overnight government shutdown, while also including provisions that give the Centers for Medicare & Medicaid Services (CMS) the option to slow down certain aspects of MIPS (the Merit-based Incentive Payment System).
According to various media reports, including this one in Business Insider, the Senate voted 71-28 to pass a massive two-year budget deal early Friday morning, just under two hours after the shutdown began. In addition to the two-year funding agreement, the bill keeps the government funded through March 23 and raises the debt ceiling, according to reports.
But the part of the bill, the Bipartisan Budget Act of 2018, that might be most interesting to health IT observers is that deep inside there is a section on implementing certain changes to MIPS, one of the payment tracks under MACRA’s (Medicare Access and CHIP Reauthorization Act of 2015) Quality Payment Program (QPP), in which eligible clinicians will have their reimbursement payments adjusted in the future depending on how well they reduce costs and provide high-quality care.
Deep inside the 652-page legislation, lawmakers propose that for each of the second, third, fourth and fifth years for which MIPS applies to payments, a clinician’s cost-cutting would never be less than 10 percent and never more than 30 percent. In other words, the “Cost” category of MIPS—one category that determines a clinician’s final MIPS score—could be weighted at just 10 percent through 2021, given this new legislation. As per the MACRA 2018 final rule that was released last fall, CMS had originally intended to have the Cost category jump from 10 percent of a clinician’s score in 2018 all the way up to 30 percent of the overall score in 2019.
At the time the final rule was released, stakeholders expressed concern that the Cost category would jump to 30 percent in 2019, believing that the leap was too far for providers at this time, many of whom are not ready to perform in the QPP at such high levels. But according to this legislation, if it becomes a law, the government will now have the option to keep the Cost component at 10 percent through 2021.
Tom Lee, Ph.D., CEO of the Chicago-based SA Ignite consulting and software services firm, who has said before that keeping the weight of the Cost component down could serve as a disservice to clinicians, says today that “Easing the ramp up of the MIPS program may result in more clinicians and organizations remaining in MIPS longer rather than entering an Advanced Alternative Payment Model (A-APM). CMS heard the cries of the physician community and created a safer sandbox for clinicians to develop and practice value-based care improvement strategies before moving to more aggressive programs such as APMs,” he says.
Lee does note that while this legislation could indeed keep the MIPS Cost component weighted at 10 percent through 2021, “CMS is mandated to continue to increase the MIPS performance threshold year-over-year to reach the required national mean or median by 2022. This will continue to encourage MIPS performance improvement.”
Meanwhile, Anders Gilberg, senior vice president, MGMA (Medical Group Management Association) government affairs, said in a statement early this morning that “The Bipartisan Budget Act of 2018 is largely a win for physician practices. Reducing burden in the MIPS program, eliminating the unelected Medicare cost-cutting board known as the IPAB, and averting a flawed misvalued-code policy that would have resulted in drastic across-the-board payment cuts in 2019 and 2020 are all top MGMA priorities.”
What’s more, the Senate bill, similar to a House one passed earlier this week, also included various telehealth items, including provisions of S. 870, the “Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017;” and H.R. 3120, legislation to ease the “meaningful use burden on providers and reduce the volume of future electronic health record-related significant hardship requests.”
To this point, the College of Healthcare Information Management Executives (CHIME) released a statement in which CHIME Board of Trustees Chair Cletis Earle stated that “this legislation marks a positive step toward infusing necessary flexibilities into the meaningful use program through the removal of the clause that calls for the measures to become "more stringent over time.”
And regarding the CHRONIC Care Act part of the bill, a HIMSS (Healthcare Information and Management Systems Society) official, Samantha Burch, senior director, Congressional affairs, said in a reaction piece that the “telehealth provisions marks an important step forward for connected care. Congress, HHS and the healthcare community have much more work to do to modernize Medicare to increase use of remote patient monitoring (RPM) and set the stage for realizing the potential of the many innovative technologies coming down the pike.”
The deal now goes back to the House for a vote, but according to the Business Insider report, “It remains unclear whether the bill has enough votes to pass the House, as members of both parties have expressed concerns about it.”
Specifically, the bill would bump limits on defense and nondefense spending by just under $300 billion combined over the next two years, and some House Republicans are worried about what this will do to the federal deficit. Meanwhile, according to the report, Democrats are unhappy that the bill does not address the Deferred Action for Childhood Arrivals (DACA) immigration program, which is on pace to end next month.
