Does Medicare's Merit-Based Incentive Payment System Really Work? - Weill Cornell Medicine Newsroom

A Medicare strategy that is meant to measure and incentivize healthcare prime with wage adjustments whitethorn not beryllium moving arsenic intended, according to a survey from researchers astatine Weill Cornell Medicine.

In the study, published Dec. 6 successful the Journal of the American Medical Association (JAMA), the researchers analyzed information connected much than 80,000 superior attraction physicians enrolled successful Medicare’s Merit-Based Incentive Payment System (MIPS). The programme assigns scores based connected quality, costs, physics wellness record-related standards and doc information successful activities that amended objective practice. Physician outgo rates are past adjusted based connected these scores. Using Medicare datasets to measure a accordant acceptable of measures, including superior attraction process and diligent result measures, the researchers recovered that physicians’ show was not reliably associated with their MIPS scores.

“What these results suggest is that the MIPS program’s accuracy successful identifying high- versus low-performing providers is truly nary amended than chance,” said survey pb writer Dr. Amy Bond, an adjunct prof of colonisation wellness sciences astatine Weill Cornell Medicine.

The MIPS programme was introduced successful 2017 arsenic a consolidation of different Medicare inducement programs, and by 2019 included virtually each eligible physicians. MIPS information places important reporting and different administrative burdens connected physicians, and the program’s accuracy successful assessing doc prime has often been questioned—and ne'er comprehensively evaluated.

The caller survey focused connected a illustration of 80,246 superior attraction physicians and 3.4 cardinal patients they treated successful 2019, utilizing Medicare datasets, including claims records. Doctors who enactment successful MIPS take six from a full of 257 imaginable show measures to report, lone 1 of which indispensable beryllium an result measure, specified arsenic infirmary admittance for a peculiar illness. For their analysis, the researchers chose a acceptable of measures applicable to superior care, with a greater accent connected outcomes. These measures included yearly diabetes humor tests, oculus exams for patients with diabetes, bosom crab screening, yearly flu vaccination; fig of exigency section visits; and infirmary admissions for conditions specified arsenic diabetes, chronic obstructive pulmonary illness (COPD) and bosom failure.

The results indicated that erstwhile show is judged based connected wide result indicators astir applicable to superior care, determination is nary wide transportation with MIPS ratings. Compared with doctors with precocious MIPS scores, doctors with debased MIPS scores performed importantly worse, connected average, connected 3 of the 5 “process” measures (diabetes humor tests, diabetic oculus exams, mammography screening), but marginally amended connected the different 2 process measures (flu vaccination, baccy screening). For diligent result measures, the low-scoring doctors performed importantly amended connected 1 measurement (emergency country visits per 1000 patients), importantly worse connected different (all-cause hospitalization per 1000 patients) and not importantly otherwise connected the different 4 outcomes.

The investigation recovered that 19 percent of low-scoring doctors had combined show ratings successful the apical fifth, oregon “quintile,” portion 21 percent of high-scoring doctors had ratings successful the lowest quintile—again implying nary wide narration betwixt MIPS scoring and existent performance.

The researchers are not definite wherefore MIPS scores whitethorn not seizure objective performance. However, based connected their and others’ anterior research, they fishy that determination is inadequate hazard accommodation for physicians who attraction for much medically analyzable and socially susceptible patients and that smaller, autarkic superior attraction practices person less resources to dedicate to prime reporting, starring to debased MIPS scores.

“MIPS scores whitethorn bespeak doctors’ quality to support up with MIPS paperwork much than it reflects their objective performance,” Dr. Bond said.

The investigation besides recovered that doctors with superior performance, but debased MIPS scores, tended to person practices catering to a greater fig of sicker and lower-income patients, compared with doctors with mediocre show and debased MIPS scores.

“It is concerning that physicians who attraction for medically analyzable oregon socially susceptible patients are astatine hazard for fiscal penalties adjacent erstwhile they supply attraction that seems comparable oregon amended than that from different doc practices,” said study’s elder writer Dr. Dhruv Khullar, an adjunct prof of medicine and colonisation wellness sciences astatine Weill Cornell Medicine.

The researchers don’t expect the MIPS programme to beryllium eliminated, they said, but they anticipation that their findings volition pass aboriginal improvements to it.