MedPAC and OIG Weigh in on MACRA

The month of December saw additional and important communications from two watchdog groups on the subject of the Medicare and CHIP Reinvestment Act (MACRA) of 2015.

First, MedPAC held a public meeting in December in follow-up to prior discussions on its stance on the Merit-Based Incentive Payment System (MIPS). We reported earlier on MedPAC’s October 5 public meeting, which was followed by additional discussion during its November and December meetings. MedPAC is developing recommendations for replacing MIPS with a new Voluntary Value Program (VVP), which would be funded by withholding a portion (e.g., 2 percent) of clinicians’ Medicare fee-for-service payments, coupled with incentives to participate in Advanced Alternative Payment Models. MedPAC expressed a sense of urgency around moving to the VVP, citing future resistance to changes by clinicians who may receive favorable payment adjustments and predicting calls to change the program once penalties begin impacting clinicians. The December meeting included a discussion of the VVP and the Commission’s plans to vote in January for inclusion in its March 2018 Report to the Congress.

We note that MACRA is still the law of the land, passed by Congress and implemented by CMS, and our best advice is to be as fully prepared for MIPS as possible, recognizing that MIPS performance already being measured in 2017 will affect payment adjustments in 2019.

Second, the Office of Inspector General (OIG) performed a follow-up review to a 2016 early implementation review of the MACRA Quality Payment Program (QPP). In reporting on its follow-up review, the OIG recognized CMS for making improvements on vulnerabilities identified in its previous review and noted two vulnerabilities critical for CMS to address in 2018.

The OIG report cited CMS’ significant progress in system development to support the QPP, finding the agency on track to deploy needed systems for MIPS data submission in January 2018. However, despite extensive work by CMS to raise clinicians’ awareness of the QPP, OIG noted that clinicians could struggle to succeed or choose not to participate in the QPP if specialized information and assistance, particularly to small and rural practices, is not available. Clinician awareness has been a big focus of our client educational workshops, roundtable events, and published materials, and we are providing individualized assistance to clients as they prepare for MACRA.

Additionally, the OIG noted that a greater risk of fraud and improper payments will exist if CMS does not assemble a comprehensive program integrity plan. The OIG reported that more than $700 million in Medicare EHR incentive overpayments were made by CMS between May 2011 and June 2014, noting that a similar risk could be perpetuated by the current self-attestation process. In one example, the OIG wrote that the MIPS data submission system allows for real-time scoring and the opportunity to correct errors. However, as OIG stated, “these same functions make it possible for a user to ‘game’ the submission system to obtain a higher MIPS score than the one to which the user is entitled, therefore potentially resulting in an improper positive payment adjustment.”

We will communicate further developments as MedPAC publishes recommendations to Congress on alternatives to the current MIPS platform and as CMS develops a comprehensive MACRA program integrity plan. We likewise encourage clinicians and their employers to keep a watchful eye out for progress in these areas.

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