Association Between Patient Social Risk and Physician Performance Scores in the First Year of the Merit-based Incentive Payment System

Khullar, Dhruv; Schpero, William L.; Bond, Amelia M.; Qian, Yuting; Casalino, Lawrence P.

doi:10.1001/jama.2020.13129

Cited by 48 publications

(60 citation statements)

References 22 publications

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“…In the first year of MIPS, payment rates were adjusted by up to ±4%; however, because the program is budget neutral and there were more high- than low-performers, actual adjustments ranged from −4 to 1.9%. 6 , 9 These percentages are set to increase, and by 2022, practices could receive payment adjustments of up to ±9% based on performance in 2020. 15…”

Section: Discussionmentioning

confidence: 99%

“…The interview protocol was developed through a literature review of MIPS and other value-based purchasing programs and prior research experience of the investigative team members. 1 – 3 , 6 , 9 , 10 , 12 , 13 It was then refined through pilot interviews with physician leaders and health care quality experts. It included questions on general impressions of the MIPS program; perceived benefits and challenges; the relevance of MIPS measures; if and how the program could be improved; how participating in the program affected patient care; whether MIPS had led practices to consider administrative changes, such as hiring new employees or interacting with other health care organizations; and other open-ended questions about the program.…”

Section: Methodsmentioning

confidence: 99%

“… 1 – 4 The Medicare Payment Advisory Commission has recommended eliminating MIPS altogether, 5 and recent studies suggest that the program may disadvantage small and independent practices, and those that serve a high proportion of low-income patients. 6 , 7 …”

Section: Introductionmentioning

confidence: 99%

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Physician Practice Leaders’ Perceptions of Medicare’s Merit-Based Incentive Payment System (MIPS)

et al. 2021

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Background Medicare’s Merit-based Incentive Payment System (MIPS) is a major value-based purchasing program. Little is known about how physician practice leaders view the program and its benefits and challenges. Objective To understand practice leaders’ perceptions of MIPS. Design and Participants Interviews were conducted from December 12, 2019, to June 23, 2020, with leaders of 30 physician practices of various sizes and specialties across the USA. Practices were randomly selected using the Medical Group Management Association’s membership database. Practices included small primary care and general surgery practices (1–9 physicians); medium primary care and general surgery practices (10–25 physicians); and large multispecialty practices (50 or more physicians). Participants were asked about their perceptions of MIPS measures; the program’s effect on patient care; administrative burden; and rationale for participation. Main Measures Major themes related to practice participation in MIPS. Key Results Interviews were conducted with 30 practices representing all US census regions. Six major themes emerged: (1) MIPS is understood as a continuation of previous value-based payment programs and a precursor to future programs; (2) measures are more relevant to primary care practices than other specialties; (3) leaders are conflicted on whether the program improves patient care; (4) MIPS creates a substantial administrative burden, exacerbated by annual programmatic changes; (5) incentives are small relative to the effort needed to participate; and (6) external support for participation can be helpful. Many participants indicated that their practice only participated in MIPS to avoid financial penalties; some reported that physicians cared for fewer patients due to the program’s administrative burden. Conclusions Practice leaders reported several challenges related to MIPS, including irrelevant measures, administrative burden, frequent programmatic changes, and small incentives. They held mixed views on whether the program improves patient care. These findings may be useful to policymakers hoping to improve MIPS. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-021-06758-w.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Physician Practice Leaders’ Perceptions of Medicare’s Merit-Based Incentive Payment System (MIPS)

et al. 2021

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“…Compared to physicians with fewer dual-eligibles, those who cared for the poor had average MIPS scores 15% lower, a difference large enough to significantly reduce Medicare’s total reimbursement rate for practices that serve the poor. 21 Only 2.8% of doctors affiliated with a health system incurred MIPS penalties in 2019 vs. 13.7% of those who were unaffiliated. Conversely, 97.1% of the affiliated doctors received MIPS bonuses, compared to 82.6% of their unaffiliated colleagues.…”

Section: Pay-for-performance Accountable Care Organizations and ‘Payimentioning

confidence: 99%

Health Care Crisis Unabated: A Review of Recent Data on Health Care in the United States

Himmelstein

Woolhandler

2020

Int J Health Serv

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We review recently published studies of U.S. health policy and the nation’s health care system. Even prior to the COVID-19 pandemic, health inequalities were widening and care was inequitably distributed. Although the Affordable Care Act’s coverage expansion improved access to care and timely cancer diagnoses, a large proportion of U.S. residents continued to avoid medical care due to concerns about costs, and access to mental health services remains particularly inadequate. Yet more evidence of private insurers’ profit-driven misbehaviors and of corruption among medical leaders continues to emerge. Misguided incentives and lax regulation encourages nominally nonprofit health care providers to mimic for-profits’ misconduct, and rapacious investors own and control an increasing share of physicians’ practices. Pharmaceutical firms wield outsize political influence and devote far more funds to rewarding investors than to research and development effort. Yet despite vigorous efforts by pharma and other commercial interests to denigrate national health insurance, polls indicate that the COVID-19 pandemic has led to increasing support for such reform.

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“…2 Additionally, in the Merit-based Incentive Payment System (MIPS), one of the nation's largest APMs, clinicians who cared for a high proportion of dual-eligible patients (eligible for both Medicare and Medicaid) consistently had lower MIPS scores, even after adjusting for patients' medical complexity. 3 Given that the RO model shares 3 of its 4 quality measures with that of MIPS (plan of care for pain, screening for depression and follow-up, and advance care plans), it may similarly penalize radiation oncologists who care for socially high-risk patients. There are already extensive racial and socioeconomic disparities in the use of evidence-based radiation treatment, such as for the treatment of breast and prostate cancers.…”

mentioning

confidence: 99%

Reforms to the Radiation Oncology Model: Prioritizing Health Equity

Erfani

Figueroa

Lam

2021

International Journal of Radiation Oncology*Biology*Physics

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Value-based health care has become a prime strategy in the US health care landscape to improve quality while controlling rising health care costs. Payors, including Medicare, have implemented alternative payment models (APMs) that tie quality and cost targets to reimbursement, but there is growing concern about how APMs affect vulnerable populations and the safety-net providers that care for them.The Centers for Medicare & Medicaid Services (CMS) recently released a radiation oncology (RO)-specific APM to disincentivize the use of highly compensated radiation modalities (prolonged fractionations, higher degree of complexity) over the use of equally effective, shorter, and simpler radiation treatments. The mandatory RO model randomizes practices into the APM by zip code and includes prospective 90-day episode-based payments for 16 cancer types. 1 Owing to implementation challenges and the uncertain effects of COVID-19, its launch was recently delayed to January 1, 2022. In the context of delays and a pandemic that has disproportionately taken the lives of poor people and racial minorities, we consider how the RO model can be improved to protect vulnerable populations from widening disparities.There are 3 main concerns about how the RO model may negatively affect vulnerable populations. First, analyses of similar APMs that incentivize value over volume suggest that they disproportionately penalize clinicians who take care of socially high-risk populations. For example, under

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Association Between Patient Social Risk and Physician Performance Scores in the First Year of the Merit-based Incentive Payment System

Cited by 48 publications

References 22 publications

Physician Practice Leaders’ Perceptions of Medicare’s Merit-Based Incentive Payment System (MIPS)

Physician Practice Leaders’ Perceptions of Medicare’s Merit-Based Incentive Payment System (MIPS)

Health Care Crisis Unabated: A Review of Recent Data on Health Care in the United States

Reforms to the Radiation Oncology Model: Prioritizing Health Equity

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