In a move to further ease the information collection and reporting burdens for independent physicians while continuing to focus on value-based care for patients, the Centers for Medicare & Medicaid Services (CMS) has announced that it worked to put Medicare Advantage providers on a more level playing field with fee-for-service providers.
CMS has said that it will advance the Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) Demonstration, which “would waive Merit-Based Incentive Payment System (MIPS) requirements for clinicians who participate sufficiently in certain Medicare Advantage plans that involve taking on risk.” The MAQI demonstration must still be approved and adopted.
Under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), independent physicians have two tracks for payment under Fee-for-Service Medicare. MIPS requires clinicians to report quality data to CMS and have their payment adjusted accordingly and Advanced Alternative Payment Models (Advanced APMs) require clinicians to take on risk for their patients’ healthcare spending.
Physicians who participate in Medicare Advantage plans have written to CMS urging recognition of their participation criteria toward MACRA’s Quality Payment Program (QPP). While CMS recognizes that some “Medicare Advantage plans are developing innovative arrangements that resemble Advanced APMs …. without this demonstration, physicians are still subject to MIPS even if they participate extensively in Advanced APM-like arrangements under Medicare Advantage.”
CMS Administrator Seema Verma says that “The MAQI Demonstration aligns with the Agency’s goal of moving to a value-based healthcare system, and aims to put Medicare Advantage on a more equal playing field with Fee-for-Service Medicare.” She adds that “CMS intends to test whether MIPS exemptions provided to clinicians under MAQI will increase participation in Medicare Advantage plans that are similar to Advanced APMs, and thereby accelerate the transition to a healthcare system that pays for value and outcomes.”
CMS is currently seeking comments on the information collection burdens associated with the demonstration.