October 2018


ASCRS Government Relations Committee chair testifies at congressional hearing supporting MIPS and maintaining viable fee-for-service option

Dr. Parekh testifies on behalf of the Alliance of Specialty Medicine Source: House Energy and Commerce Health Subcommittee


In late July, a hearing on “MACRA and MIPS: An Update on the Merit-based Incentive Payment System” took place in the House Energy and Commerce Health Subcommittee. At the hearing, Parag Parekh, MD, State College, Pennsylvania, chair of the ASCRS Government Relations Committee, testified on behalf of the Alliance of Specialty Medicine, which represents more than 100,000 physicians and surgeons.
Dr. Parekh highlighted the two value-based reimbursement tracks under Medicare enacted by MACRA: MIPS or advanced alternative payment models (APM). But he noted that for many specialists, including ophthalmologists, MIPS is the only meaningful and viable pathway. “Many specialists have no opportunity to participate in advanced APMs because they’re designed for a primary care focus,” he added.
Dr. Parekh spoke in favor of the MIPS program. “Listening to physicians’ concerns, Congress created MIPS, which streamlined the existing quality reporting programs and allows physicians to focus on measures and activities that most closely align to our practices,” he said. For ophthalmology, those measures include outcomes measures, including for cataract surgery.
In addition, it is critically important that Congress maintain a viable fee-for-service option in Medicare Part B, along with the MIPS program, to be sure that specialists can continue to meaningfully engage in quality improvement initiatives and deliver high quality care, Dr. Parekh said. For many specialists—such as ophthalmologists who have made tremendous strides in cataract surgery by reducing complications and cost variations—there are no available alternative payment models and limited opportunities to develop them. Fee-for-service remains the best reimbursement model for specialists.
Dr. Parekh thanked Congress for the recently enacted MIPS technical corrections, which further ensure specialists will be able to continue to participate in MIPS. He said the MIPS technical corrections give CMS additional flexibility to determine appropriate weight of the MIPS cost category, allow CMS to gradually increase the performance threshold before reaching mean or median standard, and exclude Medicare Part B drugs from MIPS payment adjustments and eligibility determination.
Congress should encourage CMS to make additional modifications to support more meaningful measures and lessen the complexity of reporting and scoring, Dr. Parekh said. There are currently four performance categories, each with distinct requirement and scoring methodologies. “Allowing clinicians to get credit across multiple MIPS categories by engaging in a single set of actions would make the program less confusing,” he said.
For example, Dr. Parekh said he thinks that tracking outcomes through a clinical data registry and using such data to improve patient care should count for multiple categories of MIPS. He added that the American Academy of Ophthalmology’s IRIS Registry serves as a key tool in reporting MIPS data and tracking outcomes in the ophthalmology specialty.
Measure implementation is another ongoing challenge. “Our member societies continue to develop new specialty-focused measures, but CMS threatens to eliminate them when they do not immediately produce enough data to set reliable performance benchmarks,” Dr. Parekh said. He added that CMS designates some established measures as “topped out” and removes them from the program, even when they continue to improve care and continue to be meaningful for specialty physicians.
Other witnesses at the hearing included David Barbe, MD, American Medical Association, Frank Opelka, MD, American College of Surgeons, Ashok Rai, MD, American Medical Group Association, and Kurt Ransohoff, MD, America’s Physician Groups. More from the hearing can be found at energycommerce.house.gov/hearings/macra-and-mips-an-update-on-the-merit-based-incentive-payment-system.

Contact information

: parag2020@gmail.com

ASCRS Government Relations Committee chair testifies at congressional hearing supporting MIPS and maintaining viable fee-for-service option ASCRS Government Relations Committee chair testifies at congressional hearing supporting MIPS and maintaining
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