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Should the Biden Administration Transform or Scrap MIPS?

In a recent article through Health Affairs, Dr. Joshua Liao highlighted the importance of MIPS as a policy issue facing the Biden administration:


"[The administration] faces a major health policy decision: What to do with the Merit-Based Incentive Payment System (MIPS)? Since 2017, Medicare has used MIPS to engage clinicians around the country in value-based care. The program is historically significant: As the largest pay-for-performance program in US history, MIPS replaced long-standing fee schedule updates that clinicians received through the Medicare Sustainable Growth Rate and periodic legislative fixes. Unfortunately, MIPS has drawn criticism from the policy community because of design flaws. Some physicians have also expressed disagreement with the program design and concern about unintended consequences."


The article argues that though one option to address these problems would be to simply eliminate MIPS, there are reasons not to take that approach.


  1. Doing so would not obviate the need to provide clinicians a transitional “glide path” to gradually build competencies for value-based payment

  2. Eliminating MIPS would also require consensus on new strategies for controlling health care spending, a likely infeasible task given ongoing focus on COVID-19 and the bipartisan support behind the original MIPS legislation

  3. Policymakers should preserve the underlying spirit of MIPS — bringing quality and cost accountability to Medicare fee-for-service at national scale


As Dr. Liao and colleague Dr. Amol Navathe argue, "a more practical solution would be to transform MIPS by aligning it as closely as possible with alternative payment models (APMs)—payment arrangements that more directly link payment to value-based care."


Read the article here to learn about the three steps that Drs. Liao and Navathe suggest for achieving this goal.


Read on here learn more about Dr. Liao's work in the area of MIPS and value-based payment.