Providers, physicians will earn more under MACRA's MIPS program for many years, study says

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A new study by the Brookings Institution claims physicians would earn more in Medicare reimbursements under the Merit-Based Incentive Payment System mandated by MACRA legislation than with other alternative payment models.

In the report, Brookings said even those physicians participating in Medicare's Next Generation accountable care organization model who are confident they would score well on quality and value metrics might be better off being judged under MIPS.

The Medicare Access and CHIP Reauthorization Act of 2015, known as MACRA, gives physicians two reimbursement options. On one hand they can choose MIPS, which has its own benchmarking for quality and technology use. However, physicians who take part in an advanced payment model such as ACOs or bundled payment programs would not have to follow the guidelines set up by MIPS.

[Also: CMS chief Andy Slavitt suggests possible delay in MACRA implementation]

MIPS top performers can out-earn APM performers through 2042, the study claimed.

MIPS provides $500 million each year from 2019 to 2024 to award "exceptional performance" bonuses to providers with the highest composite performance scores. The bonuses would be awarded on a sliding scale up to as high as 10 percent added to the base MIPS bonus, the study said.

Only 4 to 11 percent of physicians and providers are expected to participate in the alternative payment model, at least initially.

What's unpredictable is how the budget-neutrality factor of MIPS affects bonuses and penalties. Performance is compared against that of other physicians. One physician's increase threatens the payment of another, as bonuses and penalties offset each other, the study said.

[Also: CMS sets guidelines for access to claims data under MACRA]

However, the uncertainty of MACRA implementation for smaller practices could lead to a large numbers of physicians seeking employment by hospitals and large physician organizations, the study's authors said.

"This risks potentially leading to much higher degrees of consolidation and losses in physician productivity," they said.

Centers for Medicare and Medicaid Services Acting Administrator Andy Slavitt on Wednesday said the agency is open to delaying the implementation of MACRA in part because of concerns that smaller practices may not be ready by January 1, 2017.

CMS announced MACRA details in April and said a final rule would be released in the fall. Payments in 2019 would reflect performance starting on January 1, 2017, CMS said.

However, on Wednesday, testifying before a Senate Finance Committee, Slavitt said CMS would be open to multiple approaches including alternative start dates, shorter reporting periods and other methods to help physicians, particularly those in smaller practices, adjust to the program.

[Also: AMA outlines what physicians need to implement MACRA, presses CMS for more time]

MACRA consolidated three former programs: meaningful use incentives for electronic health records, the physician quality reporting system and the value-based payment modifier.

It also eliminated the hated sustainable growth rate formula.

Under MIPS, in 2019, 4 percent of a practice's revenue generated through Medicare fee-for-service payments will be redistributed, growing to 9 percent by 2022 and remaining at that level indefinitely.

APMs initially offers bonuses and then provides higher annual fee updates than MIPS when physicians earn a sufficient amount of their revenue, or see a high percent of their patients, through private payer models that require financial risk.

Under APM, physicians get a fixed 5 percent bonus for each of the first six years and a higher base payment rate updates than MIPS from 2026 onward, in addition to additional bonuses and penalties based on their contracts. There's no requirement to be budget neutral.

Questions remains about the different risks and rewards for MIPS versus APMs, the movement between the payment programs and the potential for additional payment models, said study authors Kavita Patel, Loren Adler, Margaret Darling, Paul Ginsburg and Steven Lieberman.

Twitter: @SusanJMorse