13 Apr 2015 Are Republicans and Democrats Creating a Mini-Death Panel for Medicare in the “Bipartisan” Doc Fix Bill?

New “Merit-Based Incentive Payment” System is Eerily Similar to Independent Payment Advisory Board

Sickest Medicare Patients Likely to Suffer Under IPAB-Like Payment System

Medicare Access and CHIP Reauthorization Act (MACR) Restructures Medicare’s Payments So Doctors Have Incentives to Avoid the Sickest Patients

Washington, D.C. – Congress is set to establish an IPAB-like payment system in Medicare, argues a new National Policy Analysis paper from the National Center for Public Policy Research.

“Medicare’s Independent Payment Advisory Board has never gotten off the ground, thanks in part to the work of conservatives and libertarians,” says Dr. David Hogberg, senior fellow at the National Center. “Now a coalition of politicians, including many Republicans, are on the verge of passing a bill that will introduce a payment system that is consistent with IPAB’s mission, incentive structure, and likely outcomes.”

In “Medicare Doc Fix Bill is IPAB-Lite,” Dr. Hogberg points out that the Medicare Access and CHIP Reauthorization Act (MACR) re-structures Medicare’s payment system so that physicians will have incentives to avoid treating the sickest patients.

“MACR is supposed to repeal Medicare’s unworkable Sustainable Growth Rate,” says Dr. Hogberg. “Fine. But why use it to do the business of the highly unpopular IPAB?”

Dr. Hogberg points out that the new payment system, the Merit-Based Incentive Payment System (MIPS), grades physicians based on how well physicians’ patients score on quality measures and how many medical resources physicians use to treat patients. Physicians will either receive bonuses or penalties based on how well they score. It is easier for physicians to receive a high grade and, thus, receive a bonus under MIPS with only moderately ill patients since such patients will score well on quality measures and require fewer treatment resources.

By contrast, sicker patients will score poorly on quality measures. Treating them will require more resources. A sicker caseload likely means a physician will fare poorly under MIPS and see his Medicare fees cut.

In short, the sickest Medicare patients will have a harder time finding physicians who will treat them thanks to MIPS.

“MIPS is exactly the sort of proposal you would expect out of IPAB,” said Dr. Hogberg. “Its ostensible purpose is to improve quality and cut costs. Its likely outcome is that it will harm the sickest patients.

“This is what happens when an unaccountable group of people pay no cost if the decisions they make are wrong. That’s the set of incentives that board members of IPAB would face. MIPS is similar. It will be run by unaccountable bureaucrats at the Centers for Medicare and Medicaid Services with advice from professional medical organizations. Neither will pay a cost – such as a loss of employment – if the decisions they make about MIPS are wrong, harming patients. That’s a recipe for bad outcomes.”

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