Economic Evaluation of the Merit-Based Incentive Payment System for Ophthalmologists

Abstract

System (MIPS) is intended to promote high-value health care through quality-related Medicare payment adjustments. OBJECTIVE To assess the economic evaluation of MIPS scoring and reporting on ophthalmologists. DESIGN, SETTING, AND PARTICIPANTSIn this retrospective, cross-sectional, multicenter economic evaluation conducted from October 10 to November 30, 2021, MIPS performance and related payment adjustments were evaluated using the US Centers for Medicare & Medicaid Service (CMS) public data files for ophthalmologists. Participants were stratified by reporting affiliation. Analysis of variance and summary statistics were used to characterize and compare total and subcategory MIPS scores and adjustments received by participants. Reported CMS methodology and performance year (PY) 2019 payment percentages were used to estimate payment adjustments for the following categories: positive MIPS adjustment plus potential additional adjustment for exceptional performance, positive MIPS adjustment, neutral payment adjustment, negative MIPS payment adjustment, and maximum negative MIPS payment adjustment. Study participants included ophthalmologists registered for Medicare Part B with participation in the Quality Payment Program (QPP) in PY 2019. MAIN OUTCOMES AND MEASURES Proportion of ophthalmologists qualifying for payment adjustments and payment adjustments.RESULTS For PY 2019, 76.5% of ophthalmologists (13 621) who registered for Medicare participated in the MIPS pathway of the QPP. Ophthalmologists practiced in a predominantly large metropolitan area (12 302; 90.3%). Roughly 99% of participants (11 182) received nonnegative reimbursement adjustments, and 92.6% (10 367) received positive adjustments. Ophthalmologists filing as individuals were less likely to achieve exceptional performance scores compared with those who had a filing category of advanced alternative payment model (APM; odds ratio [OR], 0.0003; 95% CI, 0.00002-0.00481) or group (OR, 0.21013; 95% CI, 0.19020-0.23215). When analyzing participating ophthalmologists with available Medicare payment data (11 193

In Defense of Phosphodiesterase 5 Inhibitors

“…As such, we excluded cases and controls based on these 3 variables and the results remained unchanged. 1 Moreover, the adjusted and crude incident rate ratios were similar, suggesting minimal confounding by measured confounding factors. 1 Belladelli et al also argue that men who use more aggressive erectile dysfunction therapies, such as penile injections or suppositories, likely have more severe disease, which by itself can increase the risk of ocular adverse outcomes.…”

“…1 Moreover, the adjusted and crude incident rate ratios were similar, suggesting minimal confounding by measured confounding factors. 1 Belladelli et al also argue that men who use more aggressive erectile dysfunction therapies, such as penile injections or suppositories, likely have more severe disease, which by itself can increase the risk of ocular adverse outcomes. Our study 1 used an all-phosphodiesterase 5 inhibitors (PDE5i) user cohort and defined exposure as regular users of these drugs.…”

“…To the Editor Berkowitz et al 1 analyzed the 2019 Quality Payment Program data for ophthalmologists, based on the US Centers for Medicare & Medicaid Services (CMS) public data files. There are several limitations to the study, however, that place some of these conclusions in doubt.…”

“…The authors note, "this suggests that ophthalmologists who file as individuals should consider an alternative filing approach." 1 While this sounds like a good suggestion, their options are limited (ie, solo ophthalmologists cannot file as a group, and most have no pathway for alternative payment model participation).…”

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To the Editor Erectile dysfunction (ED) affects over half of all older than 40 years. 1 Until recently, when a patient would ask if taking a phosphodiesterase inhibitor for ED was dangerous, most prescribers would respond no. Our faith in this answer may be diminished somewhat following the publication of the investigation by Etminan et al 2 In a current issue of JAMA Ophthalmology, they 2 reported an association between phosphodiesterase 5 inhibitors (PDE5Is) and an increased risk of ocular adverse events (ie, serous retinal detachment, retinal vascular occlusion, or ischemic optic neuropathy).

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