President’s Budget Proposes to Revamp and Streamline MIPS and Advanced APMs

On March 11, 2019, President Trump submitted to Congress his budget request for FY 2020. It calls for a 12 percent cut in funding for the Department of Health and Human Services (HHS). This budget request reflects the Administration’s priorities and is not binding. It is the first step in an ongoing budget debate that will play out with Congress over the next few months.  To the extent the proposals in the budget are legislative in nature, they may be particularly difficult to implement given Democratic control of the House of Representatives.

Two key proposals related to the Quality Payment Program (QPP) are included in the budget.

Simplify and Eliminate Reporting Burdens for Clinicians Participating in MIPS

Effective CY 2022, this proposal alters the Merit-based Incentive Payment System (MIPS) program by replacing the current measure reporting requirements and adopting a uniform set of broader claims calculated measures, and simplifying beneficiary surveys to assess performance at the group practice level instead of the individual clinician level during the performance period to reduce burden and provide meaningful and comparable results to clinicians and patients. This proposal would use the budget-neutral payment adjustments under the current statute to fund the incentive pool during the corresponding payment year and would retain the $500 million in annual additional performance bonus payments for top performers. There are no estimated savings associated with this proposal although it is expected to reduce the burden of participating in MIPS.

Eliminate Arbitrary Thresholds and Other Burdens to Encourage Participation in Advanced APMs

Under the current structure of the QPP, some clinicians who participate in Advanced Alternative Payment Models (APMs) may not be eligible for five percent incentive payments because they do not meet statutory thresholds. Effective CY 2020, the five percent bonus for clinicians in Advanced APMs would be paid based on physician fee schedule revenues received through models in which they participate rather than all Medicare physician fee schedule payments. The Administration estimates $280 million in savings.

Both of these proposals would require legislation to amend the current Medicare Access and CHIP Reauthorization Act statute.

The budget also includes a number of other innovation-related proposals for the Medicare and Medicaid programs. Details of these other proposals can be found in the HHS Budget in Brief which is available here.


For more information visit the McDermottPlus Payment Innovation Resource Center or contact Sheila Madhani at 202-204-1459/ or Mara McDermott at 202-204-1462/