First-Year Report Cards From the Merit-Based Incentive Payment System (MIPS)

Rathi, Vinay K.; McWilliams, J. Michael

doi:10.1001/jama.2019.1295

Cited by 41 publications

(59 citation statements)

References 4 publications

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“…In medicine, incentives have been used to improve trainee compliance with patient safety measures [30] and encourage faculty productivity in educational activities [31]. Furthermore, the recently introduced Merit-Based Incentive Payment System rewards U.S. physicians practicing higher-value care with higher fees [32]. Thus, by incentivizing examinations, residency programs might influence resident motivation and thereby improve knowledge levels.…”

Section: Discussionmentioning

confidence: 99%

Resident and program characteristics that impact performance on the Ophthalmic Knowledge Assessment Program (OKAP)

Zafar¹,

Wang²,

Srikumaran³

et al. 2019

BMC Med Educ

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Background To determine which resident and program characteristics correlate with ophthalmic knowledge, as assessed by resident Ophthalmic Knowledge Assessment Program (OKAP) performance. Methods An online survey was sent in June 2017 to all US ophthalmology residents who took the OKAP in April 2017. Results The survey response rate was 13.8% (192/1387 residents). The mean respondent age was 30.4 years, and 57.3% were male. The mean [SD] self-reported 2017 OKAP percentile was 61.9 [26.7]. OKAP performance was found to have a significant positive correlation with greater number of hours spent/week studying for the OKAPs ( p = 0.007), with use of online question banks ( p < 0.001), with review sessions and/or lectures arranged by residency programs ( p < 0.001), and with OKAP-specific didactics ( p = 0.002). On multivariable analysis, factors most predictive of residents scoring ≥75th percentile were, higher step 1 scores (OR = 2.48, [95% CI: 1.68–3.64, p < 0.001]), presence of incentives (OR = 2.75, [95% CI: 1.16–6.56, p = 0.022]), greater number of hours/week spent studying (OR = 1.09, [95% CI:1.01–1.17, p = 0.026]) and fewer hours spent in research 3 months prior to examination (OR = 1.08, [95% CI: 1.01–1.15, p = 0.020]. Lastly, residents less likely to depend on group study sessions as a learning method tended to score higher (OR = 3.40, [95% CI: 1.16–9.94, p = 0.026]). Conclusions Programs wishing to improve resident OKAP scores might consider offering incentives, providing effective access to learning content e.g. online question banks, and adjusting the curriculum to highlight OKAP material. Step 1 scores may help educators identify residents who might be at risk of not performing as well on the OKAP. Electronic supplementary material The online version of this article (10.1186/s12909-019-1637-4) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Resident and program characteristics that impact performance on the Ophthalmic Knowledge Assessment Program (OKAP)

Zafar¹,

Wang²,

Srikumaran³

et al. 2019

BMC Med Educ

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“…Our results showing patients treated by physicians with higher global centrality have reduced spending and utilization is consistent with physicians that are more central in the network potentially obtaining improved information from others in the network, and thus effectively mediating physician treatment choice [28]. Understanding high versus low cost referral strategies, both for utilization and prices, and the effectiveness of a given network structure for future healthcare spending is an important contribution with ongoing changes in the delivery system and financing structure related to physician incentives [42,43]. However, it is possible that optimizing network structure from a cost perspective may be in conflict for a given patient-care must be taken that optimizations made for the long-run efficiency of the system do not compromise patient care.…”

Section: Discussionmentioning

confidence: 93%

“…We find nuanced results of associations between local and global network connectivity statistics that suggest there is not a simple path to reducing spending through altering the structure of the physician network. As changes in the financing and delivery system advance through policy changes [42,43,47,48] and healthcare consolidation [35], future research should examine mechanisms through which this structure impacts outcomes and potential policy responses to determine ways to reduce costs while maintaining quality and coordination of care.…”

Section: Discussionmentioning

confidence: 99%

The association between patient sharing network structure and healthcare costs

2020

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Study question While physician relationships (measured through shared patients) are associated with clinical and utilization outcomes, the extent to which this is driven by local or global network characteristics is not well established. The objective of this research is to examine the association between local and global network statistics with total medical spending and utilization. Data source Data used are the 2011 Massachusetts All Payer Claims Database. Study design The association between network statistics and total medical spending and utilization (using standardized prices) is estimated using multivariate regression analysis controlling for patient demographics and health status. Data collection We limit the sample to continuously enrolled commercially insured patients in Massachusetts in 2011. Principal findings Mean patient age was 45 years, and 56.3% of patients were female. 73.4% were covered by a health maintenance organization. Average number of visits was 5.43, with average total medical spending of $4,911 and total medical utilization of $4,252. Spending was lower for patients treated by physicians with higher degree (p<0.001), eigenvector centrality (p<0.001), clustering coefficient (p<0.001), and measures reflecting the normalized degree (p<0.001) and eigenvector centrality (p<0.001) of specialists connected to a patient's PCP. Spending was higher for patients treated by physicians with higher normalized degree,

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“…These include mandatory hospital-based programs like the Hospital Readmissions Reduction Program, voluntary programs like accountable care organizations and bundled payments, and ambulatory care payment programs like the Merit-based Incentive Payment System. [9][10][11][12] At the state level, there has been additional experimentation, including global budgeting in Maryland 13 and a rural hospital global payment model in Pennsylvania, 14 among others. Private insurers have also been involved, with major shifts toward value-based care, innovative delivery models, and new experiments in vertical and horizontal integration.…”

Section: Viewpoint Page 1661mentioning

confidence: 99%

US Health Policy—2020 and Beyond

Maddox

Bauchner²,

Fontanarosa³

2019

JAMA

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Health care is always on the minds of the public, usually ranking among the top 3 concerns. Virtually all of the Democratic presidential candidates have discussed or will shortly detail health care proposals, whereas President Trump and the current administration recently expressed support for repealing the Affordable Care Act. With the presidential election just 18 months away, it is an opportune time to introduce a new health policy series in JAMA.While various proposals to improve US health care will certainly differ in content, they will all by necessity share a common theme-a focus on reducing health care costs. In 2017, US health care spending reached $3.5 trillion, and such costs now consume approximately 18% of the gross domestic product (GDP). 1 Even though there has been a slight slowing in the annual growth of health care expenditures, 2 a recent projection suggested that by 2027, health care will consume 22% of the GDP, 3 outpacing the annual rate of inflation and increases in GDP over the next 5 years. This is an unsustainable trajectory.At the same time, there are also crises of access and equity. Recent estimates suggest that nearly 14% of US residents are uninsured, and these numbers are markedly higher among people living in poverty compared with those who are wealthier, as well as among racial and ethnic minority populations compared with white populations. According to the 2017 National Healthcare Quality and Disparities Report, an estimated 40% of adults reported lacking a usual source of care, of which 15% indicated a financial or insurance reason for lacking regular access; these figures are also higher among impoverished persons and individuals of racial or ethnic minority. 4 Quality, though improving overall, remains inequitable as well: substantial differences across a range of quality domains persist for black and Hispanic individuals compared with white individuals.The key question for policy makers is whether there are achievable health policies that will reduce the annual increase in health care expenditures yet at the same time increase access to care (fewer uninsured or underinsured), improve quality, and reduce inequities. Feasible policies likely must also maintain choice, which the majority of people repeatedly maintain is important to them.To set the stage for a constructive policy debate, the first step requires defining the current starting point in coverage and spending (Table). For its population of 325 million in 2017, the United States spent $3.5 trillion on health care. Private health insurance covered approximately 197 million individuals and

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First-Year Report Cards From the Merit-Based Incentive Payment System (MIPS)

Cited by 41 publications

References 4 publications

Resident and program characteristics that impact performance on the Ophthalmic Knowledge Assessment Program (OKAP)

Resident and program characteristics that impact performance on the Ophthalmic Knowledge Assessment Program (OKAP)

The association between patient sharing network structure and healthcare costs

US Health Policy—2020 and Beyond

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