Neurosurgical Performance in the First 2 Years of Merit-Based Incentive Payment System: A Descriptive Analysis and Predictors of Receiving Bonus Payments

Abstract

BACKGROUND:The merit-based incentive payment system (MIPS) program was implemented to tie Medicare reimbursements to value-based care measures. Neurosurgical performance in MIPS has not yet been described. OBJECTIVE: To characterize neurosurgical performance in the first 2 years of MIPS. METHODS: Publicly available data regarding MIPS performance for neurosurgeons in 2017 and 2018 were queried. Descriptive statistics about physician characteristics, MIPS performance, and ensuing payment adjustments were performed, and predictors of bonus payments were identified. RESULTS: There were 2811 physicians included in 2017 and 3147 in 2018. Median total MIPS scores (99.1 vs 90.4, P < .001) and quality scores (97.9 vs 88.5, P < .001) were higher in 2018 than in 2017. More neurosurgeons (2758, 87.6%) received bonus payments in 2018 than in 2017 (2013, 71.6%). Of the 2232 neurosurgeons with scores in both years, 1347 (60.4%) improved their score. Reporting through an alternative payment model (odds ratio [OR]: 32.3, 95% CI: 16.0-65.4; P < .001) and any practice size larger than 10 (ORs ranging from 2.37 to 10.2, all P < .001) were associated with receiving bonus payments. Increasing years in practice (OR: 0.99; 95% CI: 0.982-0.998, P = .011) and having 25% to 49% (OR: 0.72; 95% CI: 0.53-0.97; P = .029) or ≥50% (OR: 0.48; 95% CI: 0.28-0.82; P = .007) of a physician's patients eligible for Medicaid were associated with lower rates of bonus payments. CONCLUSION: Neurosurgeons performed well in MIPS in 2017 and 2018, although the program may be biased against surgeons who practice in small groups or take care of socially disadvantaged patients.

Performance of Neurosurgeons Providing Safety-Net Care Under Medicare's Merit-Based Incentive Payment System

“…Other variables that were positively associated with MIPS performance included participation in MIPS as a physician group or APM and average HCC risk score of beneficiaries. The positive association between group or APM participation and performance has been extensively reported across multiple specialties, 31-37 including neurosurgery 25 ; this finding may be related to APM practices having improved infrastructure and resources for collecting and reporting performance measures. 18 The positive association between HCC risk score and performance may be partly explained by the incorporation of risk adjustment measures in later years of the program, such as the inclusion of the risk-adjusted cost subscore in 2018 and 2019 and the introduction of the CPB in 2020.…”

“…This finding aligns with previous literature showing that physicians with higher proportions of dual-eligible beneficiaries had lower MIPS scores, were more likely to receive negative payment adjustments, 18,19,23,24 and were less likely to receive bonuses. 25 Year variables and the interaction between year and safety-net status were positively associated with MIPS performance, suggesting that providers improved their performance over successive years of the program, with safety-net providers improving at a faster rate than non–safety-net providers. The accelerated improvement of safety-net providers may explain the finding that safety-net providers had a higher mean score than non–safety-net providers by 2020.…”

“…21 Previous studies examining 2017 MIPS data showed that physicians with higher proportions of dual-eligible beneficiaries had lower MIPS scores and were more likely to receive negative payment adjustments. 18,19,23,24 Within neurosurgery, Neifert et al (2022) 25 showed that neurosurgeons with ≥50% proportion of dual-eligible beneficiaries were less likely to receive bonuses in 2017 and 2018. After 2017, MIPS added some elements of risk adjustment by: (1) adjusting cost score measures (which factored into the total score during 2018 and 2019) for Hierarchical Condition Category (HCC) indicators and end-stage renal disease status 3 and (2) introducing the Complex Patient Bonus (CPB) in 2020, which provided up to 10 bonus points based on HCC risk score and the proportion of dual-eligible beneficiaries.…”

Commentary: The Impact of Frailty on Traumatic Brain Injury Outcomes: An Analysis of 691 821 Nationwide Cases

“…12 However, a recent article showed that neurosurgeons who take care of socially disadvantaged patients are penalized under performance reimbursement methods. 13…”

Commentary: Association Between Neighborhood-Level Socioeconomic Disadvantage and Patient-Reported Outcomes in Lumbar Spine Surgery

“…There is ample evidence to support this. Neurosurgeons who treat a large portion of Medicaid patients fared worse in the Merit-Based Incentive Performance System 6 and Medicaid patients had worse outcomes in the Quality Outcomes Database. 7 Safety-net hospitals are consistently penalized under value-based reimbursement.…”