The Merit‐based Incentive Payment System (MIPS): A Primer for Otolaryngologists

Rathi, Vinay K.; Naunheim, Matthew R.; Varvares, Mark A.; Holmes, Kenneth C.; Gagliano, Nancy; Hartnick, Christopher J.

doi:10.1177/0194599818774033

Cited by 14 publications

(23 citation statements)

References 3 publications

(6 reference statements)

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“…In addition, CMS should work with the AAO-HNSF to accelerate the development of additional quality measures relevant to the practice of otolaryngology. 13 In 2017, the AAO-HNSF was the primary steward for 6 of 271 quality measures included in the MIPS; in 2019, 8 of 268 quality measures were unique to otolaryngologists. 19 The CMS recently finalized plans to collaborate with clinicians and specialty societies in the creation of MIPS Value Pathways, which may help meaningfully link quality reporting to physician practice.…”

Section: Discussionmentioning

confidence: 99%

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Otolaryngologist Performance in the Merit-Based Incentive Payment System in 2017

Xiao

Rathi

Kondamuri

et al. 2020

JAMA Otolaryngol Head Neck Surg

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System (MIPS) for Medicare is the largest pay-for-performance program in the history of health care. Although the Centers for Medicare & Medicaid Services (CMS) launched the MIPS in 2017, the participation and performance of otolaryngologists in this program remain unclear.OBJECTIVE To characterize otolaryngologist participation and performance in the MIPS in 2017. DESIGN, SETTING, AND PARTICIPANTSRetrospective cross-sectional analysis of otolaryngologist participation and performance in the MIPS from January 1 through December 31, 2017, using the publicly available CMS Physician Compare 2017 eligible clinician public reporting database. MAIN OUTCOMES AND MEASURESThe number and proportion of active otolaryngologists who participated in the MIPS in 2017 were determined. Overall 2017 MIPS payment adjustments received by participants were determined and stratified by reporting affiliation (individual, group, or alternative payment model [APM]). Payment adjustments were categorized based on overall MIPS performance scores in accordance with CMS methodology: penalty (<3 points), no payment adjustment (3 points), positive adjustment (between 3 and 70 points), or bonus for exceptional performance (Ն70 points). RESULTSIn 2017, CMS required 6512 of 9526 (68.4%) of active otolaryngologists to participate in the MIPS. Among these otolaryngologists, 5840 (89.7%) participated; 672 (10.3%) abstained and thus incurred penalties (−4% payment adjustment). The 6512 participating otolaryngologists reported MIPS data as individuals (1990 [30.6%]), as groups (3033 [46.6%]), and through CMS-designated APMs (964 [14.8%]). The majority (4470 of 5840 [76.5%]) received bonuses (maximum payment adjustment, +1.9%) for exceptional performance, while a minority received only a positive payment adjustment (1006 of 5840 [17.2%]) or did not receive an adjustment (364 of 5840 [6.2%]). Whereas nearly all otolaryngologists reporting data via APMs (936 of 964 [97.1%]) earned bonuses for exceptional performance, fewer than 70% of otolaryngologists reporting data as individuals (1124 of 1990 [56.5%]) or groups (2050 of 3033 [67.6%]) earned such bonuses. Of note, nearly all otolaryngologists incurring penalties (658 of 672 [97.9%]) were affiliated with groups.CONCLUSIONS AND RELEVANCE Most otolaryngologists participating in the 2017 MIPS received performance bonuses, although variation exists within the field. As CMS continues to reform the MIPS and raise performance thresholds, otolaryngologists should consider adopting measures to succeed in the era of value-based care.

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Section: Discussionmentioning

confidence: 99%

“…4 However, the influence of MIPS on specialists, such as otolaryngologists, remains unclear. 13,14 Understanding how otolaryngologists perform in the MIPS is important to guide policy and practice. We therefore sought to examine otolaryngologist performance in the inaugural year of the MIPS.…”

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confidence: 99%

Otolaryngologist Performance in the Merit-Based Incentive Payment System in 2017

Xiao

Rathi

Kondamuri

et al. 2020

JAMA Otolaryngol Head Neck Surg

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“…48 The success of CDSSs in improving adherence to best practices in otolaryngology underscores the potential of the approach in relation to performance measures, value-based contracts, and performance-based payment models. 5,104 At the same time, clinicians and health information technologists must be cognizant of barriers, such as alert fatigue, erroneous prompts, provider trust in CDSS systems, or difficulty with interoperability across EHRs. CDSSs may also face logistical challenges arising from interprofessional team-based care models.…”

Section: Implications For Practicementioning

confidence: 99%

Clinical Decision Support Systems in Otolaryngology–Head and Neck Surgery: A State of the Art Review

Standiford

Farlow

Brenner

et al. 2021

Otolaryngol.--head neck surg.

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Objective To offer practical, evidence-informed knowledge on clinical decision support systems (CDSSs) and their utility in improving care and reducing costs in otolaryngology–head and neck surgery. This primer on CDSSs introduces clinicians to both the capabilities and the limitations of this technology, reviews the literature on current state, and seeks to spur further progress in this area. Data Sources PubMed/MEDLINE, Embase, and Web of Science. Review Methods Scoping review of CDSS literature applicable to otolaryngology clinical practice. Investigators identified articles that incorporated knowledge-based computerized CDSSs to aid clinicians in decision making and workflow. Data extraction included level of evidence, Osheroff classification of CDSS intervention type, otolaryngology subspecialty or domain, and impact on provider performance or patient outcomes. Conclusions Of 3191 studies retrieved, 11 articles met formal inclusion criteria. CDSS interventions included guideline or protocols support (n = 8), forms and templates (n = 5), data presentation aids (n = 2), and reactive alerts, reference information, or order sets (all n = 1); 4 studies had multiple interventions. CDSS studies demonstrated effectiveness across diverse domains, including antibiotic stewardship, cancer survivorship, guideline adherence, data capture, cost reduction, and workflow. Implementing CDSSs often involved collaboration with health information technologists. Implications for Practice While the published literature on CDSSs in otolaryngology is finite, CDSS interventions are proliferating in clinical practice, with roles in preventing medical errors, streamlining workflows, and improving adherence to best practices for head and neck disorders. Clinicians may collaborate with information technologists and health systems scientists to develop, implement, and investigate the impact of CDSSs in otolaryngology.

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“…4 The SGR reimbursement method was repealed because it subjected physicians and health care clinicians to an annual reimbursement cut of up to 21.2%. [3][4][5][6] Following its repeal, two payment systems were put in place to incentivize physicians and clinicians. 5,6 Those incentive payment programs were: MIPS and Alternative Payment Models.…”

Section: Introductionmentioning

confidence: 99%

The Merit-based Incentive Payment System: Pearson’s Chi-Square and Categorical Dependent Variable Models Analyzed for Domains—Effective Clinical Care and Efficiency/Cost Reduction

Shenoy

2021

JHEOR

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Background: Following the 2015 repeal of the Sustainable Growth Rate formula, the US Centers for Medicare & Medicaid Services’ formula under which physicians were reimbursed, two payment systems were put in place to incentivize physicians, one of which was the Merit-based Incentive Payment System (MIPS). MIPS emphasizes high-quality care that is accessible, affordable, and supports a healthier population. Objectives: This research aims to measure characteristics of MIPS relevant to National Quality Strategy (NQS) domains, quality measure types, and clinical specialties; categorize MIPS with NQS domains and quality measure types by MIPS specialty types; and quantify the relationship between MIPS specialties, measure types, and two NQS domains, Effective Clinical Care (ECC) and Efficiency/Cost Reduction (E/CR), for years 2017 through 2020. Methodology: The Pearson’s chi-square test examined distributions of the analyzed categorical variables. The Categorical Dependent Variable Method examined the association between the dependent and independent variables. Results: The Pearson’s chi-square test showed statistically significant distributions between ECC and E/CR when analyzed with the types of quality measures. There were more process measures (93.81% vs 89.64% [P=.000]) in 2018 versus 2017. This changed minutely with significantly less process measures (93.75% vs 93.81% [P=.000]) in 2019 versus 2018. Finally, measure types changed minutely but significantly with less process measures (93.81% vs 93.75% [P=.000]) in 2020 versus 2019. The regression model showed that ECC was significantly associated with outcome measures through all analyzed years of this research. Conclusion: The above findings show scope for including additional outcome measures, given its importance in MIPS. There is potential to increase the percentage allocation for reporting more outcome measures in quality. This re-allotment infers reporting more outcome measures aligning with priority outcome measures (PROMs). Re-allocating the incentive formula to report more outcome measures aligned with PROMs shows potential to increase reporting of more outcome measures under MIPS.

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The Merit‐based Incentive Payment System (MIPS): A Primer for Otolaryngologists

Cited by 14 publications

References 3 publications

Otolaryngologist Performance in the Merit-Based Incentive Payment System in 2017

Otolaryngologist Performance in the Merit-Based Incentive Payment System in 2017

Clinical Decision Support Systems in Otolaryngology–Head and Neck Surgery: A State of the Art Review

The Merit-based Incentive Payment System: Pearson’s Chi-Square and Categorical Dependent Variable Models Analyzed for Domains—Effective Clinical Care and Efficiency/Cost Reduction

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