Cameron J Gettel1,2, Christopher R Han3, Maureen E Canavan4, Susannah M Bernheim5,6, Elizabeth E Drye5,7, Reena Duseja8, Arjun K Venkatesh1,5. 1. Department of Emergency Medicine. 2. National Clinician Scholars Program, Department of Internal Medicine, Yale School of Medicine. 3. Yale School of Medicine. 4. Department of Internal Medicine, Cancer Outcomes and Public Policy and Effectiveness Research (COPPER). 5. Center for Outcomes Research and Evaluation. 6. Section of General Internal Medicine. 7. Department of Pediatrics, Yale School of Medicine, New Haven, CT. 8. Office of Management and Budget, Washington, DC.
Abstract
BACKGROUND: The Merit-based Incentive Payment System (MIPS) incorporates financial incentives and penalties intended to drive clinicians towards value-based purchasing, including alternative payment models (APMs). Newly available Medicare-approved qualified clinical data registries (QCDRs) offer specialty-specific quality measures for clinician reporting, yet their impact on clinician performance and payment adjustments remains unknown. OBJECTIVES: We sought to characterize clinician participation, performance, and payment adjustments in the MIPS program across specialties, with a focus on clinician use of QCDRs. RESEARCH DESIGN: We performed a cross-sectional analysis of the 2018 MIPS program. RESULTS: During the 2018 performance year, 558,296 clinicians participated in the MIPS program across the 35 specialties assessed. Clinicians reporting as individuals had lower overall MIPS performance scores (median [interquartile range (IQR)], 80.0 [39.4-98.4] points) than those reporting as groups (median [IQR], 96.3 [76.9-100.0] points), who in turn had lower adjustments than clinicians reporting within MIPS APMs (median [IQR], 100.0 [100.0-100.0] points) (P<0.001). Clinicians reporting as individuals had lower payment adjustments (median [IQR], +0.7% [0.1%-1.6%]) than those reporting as groups (median [IQR], +1.5% [0.6%-1.7%]), who in turn had lower adjustments than clinicians reporting within MIPS APMs (median [IQR], +1.7% [1.7%-1.7%]) (P<0.001). Within a subpopulation of 202,685 clinicians across 12 specialties commonly using QCDRs, clinicians had overall MIPS performance scores and payment adjustments that were significantly greater if reporting at least 1 QCDR measure compared with those not reporting any QCDR measures. CONCLUSIONS: Collectively, these findings highlight that performance score and payment adjustments varied by reporting affiliation and QCDR use in the 2018 MIPS.
BACKGROUND: The Merit-based Incentive Payment System (MIPS) incorporates financial incentives and penalties intended to drive clinicians towards value-based purchasing, including alternative payment models (APMs). Newly available Medicare-approved qualified clinical data registries (QCDRs) offer specialty-specific quality measures for clinician reporting, yet their impact on clinician performance and payment adjustments remains unknown. OBJECTIVES: We sought to characterize clinician participation, performance, and payment adjustments in the MIPS program across specialties, with a focus on clinician use of QCDRs. RESEARCH DESIGN: We performed a cross-sectional analysis of the 2018 MIPS program. RESULTS: During the 2018 performance year, 558,296 clinicians participated in the MIPS program across the 35 specialties assessed. Clinicians reporting as individuals had lower overall MIPS performance scores (median [interquartile range (IQR)], 80.0 [39.4-98.4] points) than those reporting as groups (median [IQR], 96.3 [76.9-100.0] points), who in turn had lower adjustments than clinicians reporting within MIPS APMs (median [IQR], 100.0 [100.0-100.0] points) (P<0.001). Clinicians reporting as individuals had lower payment adjustments (median [IQR], +0.7% [0.1%-1.6%]) than those reporting as groups (median [IQR], +1.5% [0.6%-1.7%]), who in turn had lower adjustments than clinicians reporting within MIPS APMs (median [IQR], +1.7% [1.7%-1.7%]) (P<0.001). Within a subpopulation of 202,685 clinicians across 12 specialties commonly using QCDRs, clinicians had overall MIPS performance scores and payment adjustments that were significantly greater if reporting at least 1 QCDR measure compared with those not reporting any QCDR measures. CONCLUSIONS: Collectively, these findings highlight that performance score and payment adjustments varied by reporting affiliation and QCDR use in the 2018 MIPS.
Authors: Cameron J Gettel; Christopher R Han; Michael A Granovsky; Carl T Berdahl; Keith E Kocher; Abhishek Mehrotra; Jeremiah D Schuur; Amer Z Aldeen; Richard T Griffey; Arjun K Venkatesh Journal: Acad Emerg Med Date: 2021-09-07 Impact factor: 3.451
Authors: Kenton J Johnston; Timothy L Wiemken; Jason M Hockenberry; Jose F Figueroa; Karen E Joynt Maddox Journal: JAMA Date: 2020-09-08 Impact factor: 56.272
Authors: Amol S Navathe; Kevin G Volpp; Kristen L Caldarella; Amelia Bond; Andrea B Troxel; Jingsan Zhu; Shireen Matloubieh; Zoe Lyon; Akriti Mishra; Lee Sacks; Carrie Nelson; Pankaj Patel; Judy Shea; Don Calcagno; Salvatore Vittore; Kara Sokol; Kevin Weng; Nichia McDowald; Paul Crawford; Dylan Small; Ezekiel J Emanuel Journal: JAMA Netw Open Date: 2019-02-01