In comparison to other industrialized nations, the United States spends about twice as much on health care as a percentage of its GDP. Despite this, many of the country’s health outcomes, such as its rates of avoidable mortality, burden of chronic diseases, and life expectancy, are far worse than those of other nations.
Policymakers are looking at government health care programmers to make sure they are successful at lowering costs while enhancing health outcomes in order to address this obstacle.
A report on the performance of healthcare professionals under the Merit-based Incentive Payment Systems (MIPS) programme, which was established by Congress in 2015 to encourage them to provide Medicare patients with higher-quality care at lower costs, was recently released by the U.S. Government Accountability Office (GAO).
The paper lists the difficulties the programme has encountered. The Centers for Medicare & Medicaid Services (CMS), the program’s administrator, anticipates that these issues may be resolved in later iterations of the programme.
The MIPS programme has a rather straightforward layout. Approximately 950,000 healthcare professionals were MIPS-eligible in 2019, and they were required to self-report on a number of measures under three separate categories: quality, improvement initiatives, and supporting interoperability.
Healthcare providers.
These healthcare providers—who may submit their reports as a group or an individual—then earn a final grade based on their comparative performance on the selected metrics and the affordability of the care they provide.
This final rating is contrasted with a threshold rating established by the CMS. A health care provider will receive a positive or negative adjustment to their future Medicare reimbursements depending on whether their final score is greater or lower than the threshold score. The extra money that professionals can receive from a positive adjustment, however, is limited by the savings Medicare makes through negative adjustments because the programme is intended to be budget neutral..
Many of the stakeholders GAO spoke with reported low returns on investment for their compliance and performance levels due to the high administrative costs connected with reporting MIPS measurements.
According to studies, smaller health care professional groups may be particularly burdened by these investments since they frequently lack the same administrative capabilities as bigger practises and health systems. The reality of high administrative costs may deter small-scale groups from self-reporting because they frequently receive fewer Medicare reimbursements overall and therefore stand to benefit less money from complying with the programme.
The MIPS programme is being questioned by businesses and health care experts as to whether it actually enhances the quality of care. The Medicare Payment Advisory Commission, an independent organisation that offers analysis and recommendations to Congress regarding Medicare, has repeatedly urged Congress to completely scrap the MIPS programme.
Stakeholders of MIPS Programs.
Stakeholders stated that because the program’s rankings are focused on reporting particular measurements rather than population-level health outcomes, they may be more indicative of programme compliance than of actual quality improvements.
Stakeholders also warned that health care practitioners would be motivated to do unnecessary tests because of this incentive for them to concentrate on adhering to the self-reporting requirements rather than improving health outcomes.
For instance, the percentage of patients over 18 who were checked for tobacco use and treated when necessary might be measured as a quality indicator under the MIPS programme. But regardless of whether the patient in front of them was there for a routine exam, a sinus infection, or a fractured bone, a primary care professional might do a cigarette consumption screening.
Stakeholders also noted that healthcare workers would be motivated to do pointless screenings as a result of this incentive for them to concentrate on adhering to the self-reporting criteria rather than improving health outcomes.
For instance, a quality indicator under the MIPS programme may evaluate the proportion of patients over 18 who received treatment when necessary after being screened for tobacco use. However, a primary care doctor might conduct a tobacco use screening on a patient regardless of whether they were there for a routine exam, a sinus infection, or a fractured bone.
The prospective MIPS Value Pathways (MVPs) initiative was cited by CMS in a 2021 proposed rule as a strategy to lessen administrative constraints, enable more direct comparisons across medical specialists, and encourage the reporting of more clinically pertinent indicators.
While the original MIPS programme will be phased down at the end of the 2027 data submission period, CMS aims to start using its MVPs programme in 2023.
The MVPs programme, according to CMS, will aim to unify measurements for specific specialty or illnesses across the various reporting categories. Patient-centered metrics like patient-reported outcomes, patient experience, and patient satisfaction will also be added to the programme. Finally, by incorporating population-health quality measures that CMS can calculate without any reporting from healthcare professionals, the initiative should lessen administrative overhead.
By implementing these strategies, the MVPs programme may be more suited than MIPs to lower Medicare beneficiaries’ medical expenses while enhancing their health results.
