Comparison of Performance of Psychiatrists vs Other Outpatient Physicians in the 2020 US Medicare Merit-Based Incentive Payment System

Abstract

Key Points Question How did psychiatrists perform in the 2020 Medicare Merit-Based Incentive Payment System (MIPS) compared with other outpatient physicians? Findings In this cross-sectional study of 9356 psychiatrists and 196 306 other outpatient physicians participating in the 2020 MIPS, psychiatrists had significantly lower performance scores, were significantly more likely to be assessed a performance penalty, and were less likely to be assessed a bonus than other physicians. Meaning Psychiatrists performed worse than other physicians in Medicare’s new mandatory outpatient value-based payment system; therefore, more research is needed to evaluate the appropriateness of MIPS measures for psychiatrists.

Value-Based Payment and Behavioral Health

“…For example, in a study of Medicare's Merit-Based Incentive Payment System comparing psychiatrists with other outpatient physicians, psychiatrists had significantly lower performance scores and, consequently, were more likely to be penalized. 6 An additional challenge is the limited data availability for valid/ nongameable risk adjustment for value-based care in general. It is especially a challenge with BH where clinical and social factors related to the characteristics of the population being served can impact quality and costs.…”

Association Between the Merit-Based Incentive Payment System and Access to Specialized Behavioral Health Care for Medicare Beneficiaries

“…Thus, it is important to understand whether CMS's risk adjustment approach fully addresses differences in case mix. Furthermore, as highlighted by Qi et al, 1 clinicians treating socially disadvantaged patients underperform in MIPS, and holding clinicians accountable for social risk factors they cannot influence has the potential to exacerbate disparities. 6 Because CMS does not adjust for social risk, the finding that psychiatrists were more likely than other physicians to treat dually eligible and non-White beneficiaries raises the question of whether their performance was affected by their patients' social circumstances.…”

“…The article by Qi and colleagues in this issue of JAMA Health Forum reports on psychiatrists’ performance compared with nonpsychiatrist outpatient physicians on the Merit-Based Incentive Payment System (MIPS), Medicare’s mandatory value-based payment (VBP) program. The authors examined 2020 MIPS final performance scores, reflecting 4 performance domains (quality, interoperability, improvement activities, and cost), and score-determined payment adjustments.…”

“…First, the need for psychiatric care will only increase as a result of the aging population, higher prevalence of behavioral health conditions among those aging into Medicare, and possibly the lasting effects of the COVID-19 pandemic. Second, as shown by the study by Qi and colleagues, psychiatrists treat a disproportionate number of beneficiaries who are dually eligible for Medicare and Medicaid. This population has more sickness, is more socially disadvantaged, and has higher costs compared with all Medicare beneficiaries, with an overrepresentation of individuals with Alzheimer disease, schizophrenia, and other serious mental illnesses .…”

“…Although MIPS contains 210 quality measures, clinicians can choose to be evaluated on as few as 6 measures, which do not need to be related to their area of expertise. As shown by Qi et al, psychiatrists had little uptake of most measures in the mental/behavioral health set, including several related to depression, a disorder that among older adults is highly disabling and life-shortening. Furthermore, the set includes few measures relevant to individuals with serious mental illnesses, and none were among the 20 most commonly selected.…”