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MIPS Requirements Could Be Waived for Certain Clinicians

CMS moved forward a demonstration that would waive MIPS requirements for clinicians participating in certain Medicare Advantage plans.

mips requirements cms quality payment program

Source: Thinkstock

By Elizabeth Snell

- The Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) Demonstration is being advanced, which would waive Merit-Based Incentive Payment System (MIPS) requirements for some clinicians, CMS announced last week.

The MIPS requirements would impact clinicians sufficiently participating in certain Medicare Advantage plans that involve taking on risk. 

“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,” CMS Administrator Seema Verma said in a 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 is one option for clinicians for payment under Fee-for-Service Medicare within the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

CMS noted that while some Medicare Advantage plans are developing innovative arrangements that resemble Advanced APMs, “physicians are still subject to MIPS even if they participate extensively in Advanced APM-like arrangements under Medicare Advantage” without the proposed demonstration.

The demonstration still needs formal approval, but CMS said it is asking for public comment on the collection burdens affiliated with the demonstration.  

Earlier this month, CMS marked the success of MIPS in the first year of the Quality Payment Program (QPP).

The agency had set a goal of having 90 percent participation among eligible clinicians and there was a reported 91 percent participation rate.

Even with the high numbers, Verma stressed that CMS was still hoping to continue reducing administrative burden on providers.

“We’re also eager to improve the clinician and patient experience through our Meaningful Measures initiative so that clinicians can spend more time providing care to their patients and improving the quality of care their patients receive,” she explained in a CMS blog post. “Within MIPS, we are adopting measures that improve patient outcomes and promote high-quality care, instead of focusing on processes.”

Along with reducing provider burden, CMS is currently evaluating stakeholder feedback to develop new strategies for improving interoperability.

On April 27 the agency asked for input on how to revise Conditions of Participation (CoPs) related to interoperability initiatives. CMS wants to push forward its MyHealthEData initiative, which was released as part of the new fiscal year 2019 CMS inpatient prospective payment system (IPPS) proposed rule. 

There have been mixed reviews on the interoperability initiatives thus far.

The American Medical Group Association (AMGA) said CMS should revise CoPs for hospitals so that providers can quickly communicate patient data.

“Improving interoperability will give medical groups the ability to transform the quality of care delivered to patients,” AMGA President and CEO Jerry Penso, MD stated. “By allowing care providers more real-time access to electronic patient information, CMS can help us achieve a far more interoperable system that will foster care coordination and improve patient engagement.”

The American Hospital Association (AHA) wrote in its response that CMS should not create CoP requirements that promote interoperability. However, AHA recommended that CMS still focus on other ways to encourage health data exchange.

“The AHA recommends that CMS not implement a CoP/CfC to increase interoperability across the continuum of care because post-acute care providers were not provided the resources or incentives to adopt health IT and creating this requirement would put another unfunded mandate on these organizations,” AHA said.

“Establish a framework for interoperability such that the technology and governance of health information exchange are universally and consistently implemented and demonstrable,” the association continued.

AHA added that CMS should postpone developing any initiatives or new requirements related to interoperability until after TEFCA is finalized.

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