Physicians in Congress propose fix for troubled Merit-based Incentive Payment System

Two physicians in Congress are proposing a potential fix for the troubled Merit-based Incentive Payment System, or MIPS.  

Reps. Mariannette Miller-Meeks, MD, R-Iowa, and Herb Conaway Jr., MD, on Thursday introduced the Medicare Physician Data-Driven Performance Payment System Act, drawing praise from the House of Medicine. The legislation seeks to reduce administrative burdens radiologists and other physicians face while modernizing the Medicare payment system. 

Lawmakers hope to do so by establishing the Data-Driven Performance Payment System, or DPPS, which is supported by over 100 medical societies including several in radiology. Miller-Meeks and Conaway said the change would help improve fairness and transparency in value-based payment reforms while reducing unnecessary administrative burdens. 

“For too long, Medicare’s current payment system has placed unnecessary burdens on physicians and failed to reflect the realities of patient care,” Miller-Meeks said in a statement April 30. “As a physician, I’ve seen how MIPS creates excessive red tape, disproportionately impacts small and rural practices, and does not always capture the quality of care being delivered. This legislation takes a more practical, data-driven approach that supports providers, strengthens rural healthcare, and ensures patients receive the care they deserve.”

MIPS was first established through the Medicare Access and CHIP Reauthorization Act of 2015. It aims to evaluate physician performance using a combination of factors including quality, cost and reporting metrics, with scores dictating whether docs receive payment penalties or bonuses under a budget-neutral system. However, radiology leaders have reported numerous challenges with the program. In January, the Radiology Business Management Association urged Congress to scrap MIPS, noting that its structure often amplifies disparities, alongside high compliance costs, minimal benefits, and complex and burdensome requirements. 

The American Medical Association has suggested the Data-Driven Performance Payment System to fix some of MIPS’ shortcomings. Key reforms would include reducing “excessive” penalties and creating a more “balanced” payment structure, lawmakers note. DPPS also would reinvest funds into quality improvement and support for under-resourced physician practices. Additionally, it would provide quarterly performance feedback to help docs make real-time adjustments, increase transparency in cost attribution to support better decision-making, and “protect physicians from penalties” driven by insufficient data. Along with RBMA, the American College of Radiology, American Society of Neuroradiology, Association of Academic Radiology, Society of Interventional Radiology, and American Society for Radiation Oncology also have endorsed DPPS.

The AMA noted that physicians have grappled with a “multitude of problematic issues” associated with MIPS over the last decade. Challenges have included “steep penalties” and “burdensome measures that don’t lead to improved care quality,” noted association President Bobby Mukkamala, MD. Onerous MIPS requirements have overwhelmed many physicians he added, and especially those in private practice. 

One study estimated that MIPS costs practices about $12,800 per physician annually and results in over 53 hours spent per year on quality assurance tasks.

“This reality of devoting significant time to tasks that do not improve patient health and yet still result in penalties is prompting private practices to close and exacerbating the trend of care shifting to higher cost settings,” Mukkamala said in the announcement from the two lawmakers. “We commend Reps. Miller-Meeks and Conaway for their leadership in introducing this legislation that seeks to improve the MIPS program.”

The Medical Group Management Association also voiced its support for the legislation on Thursday, saying it looks forward to working with Congress to “pass this important bill.”

“For years, MGMA members have expressed frustration with the significant administrative burden associated with reporting under MIPS,” said Anders Gilberg, senior VP of government affairs for the association, which represents over 15,000 group medical practices across radiology and other specialties. “This burden is exacerbated by the MIPS program's tournament-style model, which increases payments to practices that meet onerous quality reporting requirements by cutting payments to practices that don’t.”