MedPAC, MIPS & VVP: What You Need to Know

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Since the adoption of MIPS in 2017, there’s been some debate over whether MIPS does what it intends to do, which is reward providers for the value of their care and for positive patient outcomes.

This month, the Medicare Payment Advisory Commission (MedPAC) voted 14-2 to repeal and replace MIPS with the Voluntary Value Program (VVP). A little lost? We’re here to break it down for you.

What’s the VVP?

The Voluntary Value Program would essentially make value-based reimbursement voluntary. Clinicians could elect to be measured as part of a voluntary group to qualify for a value payment scored on their group’s performance on a set of population-based measures — and measures would be based on claims data rather than criteria meaningful use demands doctors use within their EHRs. (Healthcare IT News)

The new pay model would evaluate groups of clinicians on performance-based measures, such as patient mortality rates or spending per beneficiary following hospitalization.

The measures would be claims-based. The CMS, not providers would have to track clinician performance. This approach would reduce regulatory burden now placed on doctors, MedPAC said. (Modern Healthcare)

Why get rid of MIPS?

MedPAC worries that the system is too burdensome for physicians and won’t actually push them to improve care. Some have criticized MIPS for measuring how doctors perform, instead of whether or not patient care was improved by the provider’s decisions. Those who voted in favor believe that VVP is a better way of encouraging providers to provide high-quality care.

What’s the pushback?

One concern with scrapping MIPS is that doctors are finally getting used to it and have the infrastructure in place to support it. Some worry that providers will have settled into MIPS and invested time and money in infrastructure, causing frustration and resistance when VVP is introduced, especially since changes wouldn’t happen until 2019 or 2020.

Another concern is around the voluntary groups. Some are concerned that docs with healthy patients will band together, making it challenging for docs with less healthy patients to join a group and receive incentives.

Lastly, VVP takes back the control that MIPS was intended to give physicians. From Modern Healthcare,

“‘It would conscript physician groups into virtual groups and evaluate them on broad claims-based measures which is inconsistent with the congressional intent in MACRA to put physicians in the driver seat of Medicare’s transition from volume to value,’ Anders Gilberg, senior vice president of government affairs at MGMA said in a statement.”

Is this a sure thing?

Not quite yet. MedPAC, whose 16 members include physicians, healthcare executives, and other policy experts charged with advising the Department of Health and Human Services on Medicare policy issues, will present the recommendations on MIPS to the Department of Health and Human Services in March. From there, it’s up to Congress to vote yay or nay. Stay tuned.

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