Thesis

Limitations of the Merit-based Incentive Payment System

As a result of the passage of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), it appears value-based care is the future of healthcare in America. Value-based care focuses on quality instead of quantity and is projected to decrease the burden of healthcare costs and establish new ways to reimburse providers for caring for Medicare patients. Though it is certainly a development from our former fee-for service payment system, there are many opportunities for improvement in the new Quality Payment Program created by MACRA, especially the Merit-based Incentive Payment System (MIPS). The purpose of this literature review is to discuss the limitations of MIPS and determine possible solutions. Overall, the 2018 performance year showed that more clinicians are receiving a positive payment adjustment in 2020 compared to the 2017 performance year, as well as more rural and small practices. Though these results show that there is progress being made, this analysis discovered that MIPS' complex reporting measures impede meaningful payment and delivery reform and innovation. In addition, vulnerable populations are not being considered as well as those providers who provide care to those populations, and population health-focused quality measures are increasing the reporting burden on providers, causing patient and provider satisfaction to decline. Political dispute and resentment over the future of the Affordable Care Act will continue for years to come, as well as structural modifications to the Medicare and Medicaid programs, finding the most efficient methods to improve care quality, decreasing redundant and wasteful care, and controlling increasing expenses. MIPS' first performance year was in 2017, meaning that it has been a very short period since it was implemented. Additionally, there is a 2-year gap in performance results. Limitations to this research include insufficient data and published research on the subject, as well as the change in presidential committees and the unknown future of the Affordable Care Act.

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