Medicare’s Quality Payment Program places a human aim inside an administrative system: rewarding high-quality care. CMS’s final rule, published November 4, 2016, uses MIPS and Advanced Alternative Payment Models as its two avenues. For this November 12 retrospective, the ethical distinction is straightforward: designing a reward does not establish that a patient received better treatment. [2016-25240][2016-10032]

The May 9 proposal makes measurement choices visible. It envisaged standards across four performance categories and different scoring for clinicians in certain alternative payment models. Scores are therefore products of specified rules, not free-standing judgments about the worth of a clinician or patient. That is our ethical reading, not an independent evaluation of the program. [2016-25240][2016-10032]

The final rule acknowledges practical constraints through its transition. It takes effect January 1, 2017, while 2017 performance feeds 2019 MIPS adjustments. It allows different participation paces and excludes clinicians with at most $30,000 in Medicare Part B allowed charges or at most 100 Medicare patients. Identical obligations cannot be assumed. [2016-25240][2016-10032]

Our stewardship question is whether measurement serves the people whose care it describes while giving practices a workable way to participate. The accommodations address entry; they cannot answer that question alone. These agency documents are stages of one rulemaking, not independent proof of improved care. Respect for patients calls for separating intended benefits from claims that those benefits have already arrived. [2016-25240][2016-10032]

Source documents

  1. Medicare Program; Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive Under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Modelshttps://www.govinfo.gov/content/pkg/FR-2016-11-04/html/2016-25240.htm
  2. Medicare Program; Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive Under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Modelshttps://www.govinfo.gov/content/pkg/FR-2016-05-09/html/2016-10032.htm