Doctors say MIPS on track to be SGR 2.0 if not fixed

The CMS is undermining Congress’ efforts to help doctors move to value-based care, leaders from key medical societies told House lawmakers last week. In a hearing before the Energy and Commerce health subcommittee, physicians claimed that the CMS has let too many doctors sit out of reporting to the Merit-based Incentive Payment System.

The CMS has proposed that physician practices with less than $90,000 in Medicare revenue or fewer than 200 unique Medicare patients per year should be exempt from MIPS. With all the opt-outs, approximately 40% of the 1.5 million doctors billing Medicare will have to comply with the system.

Dr. Ashok Rai, AMGA board chair and

CEO of Prevea Health, said if the CMS doesn’t reverse course on its opt-out policy, MIPS will be no better than the much-maligned sustainable growthrate formula that MACRA replaced. “It’s becoming SGR 2.0,” Rai said. “MIPS was supposed to be the on-ramp to value and they’ve created an exit ramp.”

MIPS relies on a budget-neutral pool to reward or penalize doctors based on their performance. Because of the opt-outs, MIPS participants can expect just 2% in bonuses if they perform well. That’s well below the 7% lawmakers envisioned when they drafted MACRA, Rai said.

Several lawmakers expressed concern that MACRA wouldn’t be able to meet its promised goals. Rep. Buddy Carter (R-Ga.) said that the GOP Doctors Caucus also sent a letter to the CMS earlier this month regarding the opt-outs.