As the Texas Medical Association continues to fight the 2024 Medicare physician pay cut, its advocacy already has paid off in other areas.
These include the 2024 Medicare physician fee schedule components related to the Quality Payment Program, of which the Merit-Based Incentive Payment System (MIPS) is a part.
The Centers for Medicare & Medicaid Services (CMS) initially proposed to raise the minimum score necessary for MIPS participants to avoid a financial penalty of up to 9% from 75 points to 82 points. That would pile on top of the nearly 3.4% across-the-board Medicare cut.
But the federal agency yielded to TMA’s concerns about the proposal and the impact of constant changes to MIPS on its participants. As a result, the current fee schedule maintains the 75-point threshold for the 2024 performance year. The weighting of the four MIPS performance categories – 30% for quality, 30% for cost, 25% for promoting interoperability, and 15% for improvement activities – also remains unchanged.
Houston internist Gary Sheppard, MD, chair of TMA’s Council on Socioeconomics, considers this a win for medicine that will provide some much-needed stability to participants. In previous years, CMS has regularly increased the threshold and changed the category weights, rendering obsolete the workflow physician practices had only just implemented.
“Basically, [CMS kept] moving the finish line,” he said.
Gabriela Espinoza, practice manager for Laredo family physician Ruben Bocanegra, MD, is familiar with this scramble. The solo practice is not required to participate in MIPS but does so voluntarily.
Ms. Espinoza cites two reasons for this. First, she expects the practice will eventually care for enough Medicare patients that it will become eligible for MIPS. In the meantime, she wants to familiarize herself with the onerous reporting process without the threat of payment penalties.
The practice also participates in an accountable care organization, a group of clinicians that assumes accountability for improving the quality and cost of care for a group of Medicare patients. Tracking MIPS metrics – and those from similar programs under Medicaid and private payers – helps her ensure the practice will meet its quality goals. (See “Middle Ground?” page 38.)
“The value really is that we can see as a practice where we stand with our patients, that we are really doing what is good for them, prevention-wise,” she said.
But these benefits aren’t without their costs. Ms. Espinoza laments the huge administrative burden associated with MIPS, one that requires overtime for the practice’s four-person staff and contributes to physician and staff burnout. As a result, the practice is weighing whether to integrate with a hospital system, which would have more resources to devote to MIPS and other quality programs.
“If this continues, we won’t be able to survive much longer,” she said.
Emma Freer
Associate Editor
(512) 370-1383