1
|
Harris A, Philbin S, Post B, Jordan N, Beestrum M, Epstein R, McHugh M. Cost, Quality, and Utilization After Hospital-Physician and Hospital-Post Acute Care Vertical Integration: A Systematic Review. Med Care Res Rev 2024:10775587241247682. [PMID: 38708895 DOI: 10.1177/10775587241247682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
Vertical integration of health systems-the common ownership of different aspects of the health care system-continues to occur at increasing rates in the United States. This systematic review synthesizes recent evidence examining the association between two types of vertical integration-hospital-physician (n = 43 studies) and hospital-post-acute care (PAC; n = 10 studies)-and cost, quality, and health services utilization. Hospital-physician integration is associated with higher health care costs, but the effect on quality and health services utilization remains unclear. The effect of hospital-PAC integration on these three outcomes is ambiguous, particularly when focusing on hospital-SNF integration. These findings should raise some concern among policymakers about the trajectory of affordable, high-quality health care in the presence of increasing hospital-physician vertical integration but perhaps not hospital-PAC integration.
Collapse
Affiliation(s)
- Alexandra Harris
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sarah Philbin
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Brady Post
- Northeastern University, Boston, MA, USA
| | - Neil Jordan
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Molly Beestrum
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Richard Epstein
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Megan McHugh
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
2
|
Deans CF, Abdeen AR, Ricciardi BF, Deen JT, Schabel KL, Sterling RS. New CMS Merit-Based Incentive Payment System Value Pathway After Total Knee and Hip Arthroplasty: Preparing for Mandatory Reporting. J Arthroplasty 2024; 39:1131-1135. [PMID: 38278186 DOI: 10.1016/j.arth.2024.01.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 12/30/2023] [Accepted: 01/13/2024] [Indexed: 01/28/2024] Open
Abstract
This article discusses the implementation of a new Merit-Based Incentive Payment System Value Pathway (MVPs) applicable to elective total hip and total knee arthroplasty as created by Medicare and Medicaid Services (CMS) - the Improving Care for Lower Extremity Joint Repair MVP (MVP ID: G0058). We describe specific quality measures, surgeon-hospital collaborations, future developments with Quality Payment Program, and how lessons from early implementation will empower clinicians to participate in the refining of this MVP. The CMS has designed MVPs as a subset of measures relevant to a specialty or medical condition, in an effort to reduce the burden of reporting and improve assessment of care quality. Physicians and payors must be mindful of detrimental effects these measures in their current form may have on surgeons, institutions, and patients, including disincentivizing care for sicker or more vulnerable populations, and increased administrative costs. Early voluntary participation is crucial to gain valuable experience for the orthopedic community and in an effort to work alongside CMS to maximize care while minimizing cost for patients and burden for providers.
Collapse
Affiliation(s)
- Christopher F Deans
- Department of Orthopaedic Surgery & Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska; American Association of Hip and Knee Surgeons Health Policy Fellowship Program, Rosemont, Illinois
| | - Ayesha R Abdeen
- Department of Orthopaedic Surgery, Boston Medical Center, Boston, Massachusetts
| | - Benjamin F Ricciardi
- Department of Orthopaedic Surgery, University of Rochester Medical Center, Rochester, New York
| | | | - Kathryn L Schabel
- Department of Orthopaedics & Rehabilitation, Oregon Health & Science University, Portland, Oregon
| | - Robert S Sterling
- Department of Orthopaedic Surgery, George Washington University, Washington, District of Columbia
| |
Collapse
|
3
|
Ng GY, DiGiorgio AM. Performance of Neurosurgeons Providing Safety-Net Care Under Medicare's Merit-Based Incentive Payment System. Neurosurgery 2024:00006123-990000000-01014. [PMID: 38197638 DOI: 10.1227/neu.0000000000002824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 11/28/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Under the Merit-Based Incentive Payment System (MIPS), Medicare evaluates provider performance to determine payment adjustments. Studies examining the first year of MIPS (2017) showed that safety-net providers had lower MIPS scores, but the performance of safety-net physicians over time has not been studied. This study aimed to examine the performance of safety-net vs non-safety-net neurosurgeons in MIPS from 2017 to 2020. METHODS Safety-net neurosurgeons were defined as being in the top quartile according to proportion of dual-eligible beneficiaries and non-safety-net in the bottom quartile. Outcomes were total MIPS scores and dual-eligible proportion over time. In this descriptive study, we evaluated ordinary least squares regression models with SEs clustered at the physician level. Covariates of interest included safety-net status, year, and average Hierarchical Condition Category risk score of beneficiaries. RESULTS There were 2796-3322 physicians included each year between 2017 and 2020. Mean total MIPS scores were not significantly different for safety-net than non-safety-net physicians in 2017 but were greater for safety-net in 2018 (90.7 vs 84.5, P < .01), 2019 (86.4 vs 81.5, P < .01), and 2020 (90.9 vs 86.7, P < .01). Safety-net status (coefficient -9.11; 95% CI [-13.15, -5.07]; P < .01) and participation in MIPS as an individual (-9.89; [-12.66, -7.13]; P < .01) were associated with lower scores while year, the interaction between safety-net status and year, and participation in MIPS as a physician group or alternative payment model were associated with higher scores. Average Hierarchical Condition Category risk score of beneficiaries (-.011; [-.015, -.006]; P < .01) was associated with decreasing dual-eligible case mix, whereas average age of beneficiaries (.002; [.002, .003]; P < .01) was associated with increasing dual-eligible case mix. CONCLUSION Being a safety-net physician was associated with lower MIPS scores, but safety-net neurosurgeons demonstrated greater improvement in MIPS scores than non-safety-net neurosurgeons over time. Providers with higher-risk patients were more likely to decrease their dual-eligible case mix over time.
Collapse
Affiliation(s)
- Grace Y Ng
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Anthony M DiGiorgio
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
- Mercatus Center at George Mason University, Washington, District of Columbia, USA
| |
Collapse
|
4
|
Sinaiko AD, Curto VE, Ianni K, Soto M, Rosenthal MB. Utilization, Steering, and Spending in Vertical Relationships Between Physicians and Health Systems. JAMA HEALTH FORUM 2023; 4:e232875. [PMID: 37656471 PMCID: PMC10474555 DOI: 10.1001/jamahealthforum.2023.2875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 07/06/2023] [Indexed: 09/02/2023] Open
Abstract
Importance Vertical relationships (eg, ownership or affiliations, including joint contracting) between physicians and health systems are increasing in the US. Objective To analyze how vertical relationships between primary care physicians (PCPs) and large health systems are associated with changes in ambulatory and acute care utilization, referral patterns, readmissions, and total medical spending for commercially insured individuals. Design, Setting, and Participants This case-control study with a repeated cross-section, stacked event design analyzed outcomes of patients whose attributed PCP entered a vertical relationship with a large health care system in 2015 or 2017 compared with patients whose attributed PCP was either never or always in a vertical relationship with a large health system from 2013 to 2017 in the state of Massachusetts. The sample consisted of commercially insured patients who met enrollment criteria and who were attributed to PCPs who were included in the Massachusetts Provider Database in 2013, 2015, and 2017 and for whom vertical relationships were measured. Enrollee and claims data were obtained from the 2013 to 2017 Massachusetts All-Payer Claims Database. Statistical analyses were conducted between January 5, 2021, and June 5, 2023. Exposure Evaluation-and-management visit with attributed PCP in 2015 to 2017. Main Outcomes and Measures Outcomes (which were measured per patient-year [ie, per patient per year from January to December] in this sample) were utilization (count of specialist physician visits, emergency department [ED] visits, and hospitalizations overall and within attributed PCP's health system), spending (total medical expenditures and use of high-price hospitals), and readmissions (readmission rate and use of hospitals with a low readmission rate). Results The sample of 4 030 224 observations included 2 147 303 females (53.3%) and 1 881 921 males (46.7%) with a mean (SD) age of 35.07 (19.95) years. Vertical relationships between PCPs and large health systems were associated with an increase of 0.69 (95% CI, 0.34-1.04; P < .001) in specialist visits per patient-year, a 22.64% increase vs the comparison group mean of 3.06 visits, and a $356.67 (95% CI, $77.16-$636.18; P = .01) increase in total medical expenditures per patient-year, a 6.26% increase vs the comparison group mean of $5700.07. Within the health care system of the attributed PCPs, the number of specialist visits changed by 0.80 (95% CI, 0.56-1.05) per patient year (P < .001), a 29.38% increase vs the comparison group mean of 2.73 specialist visits per patient-year. The number of ED visits changed by 0.02 (95% CI, 0.01-0.03) per patient year (P = .001), a 14.19% increase over the comparison group mean of 0.15 ED visits per patient-year. The number of hospitalizations changed by 0.01 (95% CI, 0.00-0.01) per patient-year (P < .001), a 22.36% increase over the comparison group mean of 0.03 hospitalizations per patient-year. There were no differences in readmission outcomes. Conclusions Results of this case-control study suggest that vertical relationships between PCPs and large health systems were associated with steering of patients into health systems and increased spending on patient care, but no difference in readmissions was found.
Collapse
Affiliation(s)
- Anna D. Sinaiko
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Vilsa E. Curto
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Katherine Ianni
- Harvard PhD Program in Health Policy, Harvard University, Cambridge, Massachusetts
| | - Mark Soto
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Meredith B. Rosenthal
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| |
Collapse
|
5
|
He W, Li M, Cao L, Liu R, You J, Jing F, Zhang J, Zhang W, Feng M. Introducing value-based healthcare perspectives into hospital performance assessment: A scoping review. J Evid Based Med 2023. [PMID: 37228246 DOI: 10.1111/jebm.12534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/18/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Value-based healthcare (VBHC) puts patient outcomes at the center of the healthcare process while optimizing the use of hospital resources across multiple stakeholders. This scoping review was conducted to summarize how VBHC had been represented in theory and in practice, how it had been applied to assess hospital performance, and how well it had been ultimately implemented. METHODS For this review, we followed the PRISMA-ScR protocol and searched five major online databases for articles published between January 2006 and July 2022. We included original articles that used the concept of VBHC to conduct performance assessments of healthcare organizations. We extracted and analyzed key concepts and information on the dimensions of VBHC, specific strategies and methods for using VBHC in performance assessment, and the effectiveness of the assessment. RESULTS We identified 48 eligible studies from 7866 articles. Nineteen nonempirical studies focused on the development of a VBHC performance assessment indicator system, and 29 empirical studies reported on the ways and points of introducing VBHC into performance assessment and its effectiveness. Ultimately, we summarized the key dimensions, processes, and effects of performance assessment after introducing VBHC. CONCLUSION Current healthcare performance assessment has begun to focus on implementing VBHC as an integrated strategy, and future work should further clarify the reliability of metrics and their association with evaluation outcomes and consider the effective integration of clinical outcomes and patient-reported outcomes.
Collapse
Affiliation(s)
- Wenbo He
- Institute of Hospital Management, West China Hospital of Sichuan University, Chengdu, China
- Saw Swee Hock School of Public Health and Institute of Data Science, National University of Singapore, Singapore
| | - Meixuan Li
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Liujiao Cao
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, China
| | - Rui Liu
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jiuhong You
- School of Rehabilitation Sciences, West China Hospital of Sichuan University, Chengdu, China
| | - Fangyuan Jing
- Basic Discipline of Chinese and Western Integrative, West China Hospital, Sichuan University, Chengdu, China
| | - Jiawen Zhang
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Wei Zhang
- West China Biomedical Big Data Center, West China Hospital of Sichuan University, Chengdu, China
| | - Mengling Feng
- Saw Swee Hock School of Public Health and Institute of Data Science, National University of Singapore, Singapore
| |
Collapse
|
6
|
Care Disruption During COVID-19: a National Survey of Hospital Leaders. J Gen Intern Med 2023; 38:1232-1238. [PMID: 36650332 PMCID: PMC9845025 DOI: 10.1007/s11606-022-08002-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 12/23/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND The COVID-19 pandemic caused massive disruption in usual care delivery patterns in hospitals across the USA, and highlighted long-standing inequities in health care delivery and outcomes. Its effect on hospital operations, and whether the magnitude of the effect differed for hospitals serving historically marginalized populations, is unknown. OBJECTIVE To investigate the perspectives of hospital leaders on the effects of COVID-19 on their facilities' operations and patient outcomes. METHODS A survey was administered via print and electronic means to hospital leaders at 588 randomly sampled acute-care hospitals participating in Medicare's Inpatient Prospective Payment System, fielded from November 2020 to June 2021. Summary statistics were tabulated, and responses were adjusted for sampling strategy and non-response. RESULTS There were 203 responses to the survey (41.6%), with 20.7% of respondents representing safety-net hospitals and 19.7% representing high-minority hospitals. Over three-quarters of hospitals reported COVID testing shortages, about two-thirds reported staffing shortages, and 78.8% repurposed hospital spaces to intensive care units, with a slightly higher proportion of high-minority hospitals reporting these effects. About half of respondents felt that non-COVID inpatients received worsened quality or outcomes during peak COVID surges, and almost two-thirds reported worsened quality or outcomes for outpatient non-COVID patients as well, with few differences by hospital safety-net or minority status. Over 80% of hospitals participated in alternative payment models prior to COVID, and a third of these reported decreasing these efforts due to the pandemic, with no differences between safety-net and high-minority hospitals. CONCLUSIONS COVID-19 significantly disrupted the operations of hospitals across the USA, with hospitals serving patients in poverty and racial and ethnic minorities reporting relatively similar care disruption as non-safety-net and lower-minority hospitals.
Collapse
|
7
|
Bond AM, Schpero WL, Casalino LP, Zhang M, Khullar D. Association Between Individual Primary Care Physician Merit-based Incentive Payment System Score and Measures of Process and Patient Outcomes. JAMA 2022; 328:2136-2146. [PMID: 36472595 PMCID: PMC9856441 DOI: 10.1001/jama.2022.20619] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE The Medicare Merit-based Incentive Payment System (MIPS) influences reimbursement for hundreds of thousands of US physicians, but little is known about whether program performance accurately captures the quality of care they provide. OBJECTIVE To examine whether primary care physicians' MIPS scores are associated with performance on process and outcome measures. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study of 80 246 US primary care physicians participating in the MIPS program in 2019. EXPOSURES MIPS score. MAIN OUTCOMES AND MEASURES The association between physician MIPS scores and performance on 5 unadjusted process measures, 6 adjusted outcome measures, and a composite outcome measure. RESULTS The study population included 3.4 million patients attributed to 80 246 primary care physicians, including 4773 physicians with low MIPS scores (≤30), 6151 physicians with medium MIPS scores (>30-75), and 69 322 physicians with high MIPS scores (>75). Compared with physicians with high MIPS scores, physicians with low MIPS scores had significantly worse mean performance on 3 of 5 process measures: diabetic eye examinations (56.1% vs 63.2%; difference, -7.1 percentage points [95% CI, -8.0 to -6.2]; P < .001), diabetic HbA1c screening (84.6% vs 89.4%; difference, -4.8 percentage points [95% CI, -5.4 to -4.2]; P < .001), and mammography screening (58.2% vs 70.4%; difference, -12.2 percentage points [95% CI, -13.1 to -11.4]; P < .001) but significantly better mean performance on rates of influenza vaccination (78.0% vs 76.8%; difference, 1.2 percentage points [95% CI, 0.0 to 2.5]; P = .045] and tobacco screening (95.0% vs 94.1%; difference, 0.9 percentage points [95% CI, 0.3 to 1.5]; P = .001). MIPS scores were inconsistently associated with risk-adjusted patient outcomes: compared with physicians with high MIPS scores, physicians with low MIPS scores had significantly better mean performance on 1 outcome (307.6 vs 316.4 emergency department visits per 1000 patients; difference, -8.9 [95% CI, -13.7 to -4.1]; P < .001), worse performance on 1 outcome (255.4 vs 225.2 all-cause hospitalizations per 1000 patients; difference, 30.2 [95% CI, 24.8 to 35.7]; P < .001), and did not have significantly different performance on 4 ambulatory care-sensitive admission outcomes. Nineteen percent of physicians with low MIPS scores had composite outcomes performance in the top quintile, while 21% of physicians with high MIPS scores had outcomes in the bottom quintile. Physicians with low MIPS scores but superior outcomes cared for more medically complex and socially vulnerable patients, compared with physicians with low MIPS scores and poor outcomes. CONCLUSIONS AND RELEVANCE Among US primary care physicians in 2019, MIPS scores were inconsistently associated with performance on process and outcome measures. These findings suggest that the MIPS program may be ineffective at measuring and incentivizing quality improvement among US physicians.
Collapse
Affiliation(s)
- Amelia M. Bond
- Division of Health Policy and Economics, Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - William L. Schpero
- Division of Health Policy and Economics, Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - Lawrence P. Casalino
- Division of Health Policy and Economics, Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - Manyao Zhang
- Division of Health Policy and Economics, Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - Dhruv Khullar
- Division of Health Policy and Economics, Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
| |
Collapse
|
8
|
Sherry TB, Damberg CL, DeYoreo M, Bogart A, Agniel D, Ridgely MS, Escarce JJ. Is Bigger Better?: A Closer Look at Small Health Systems in the United States. Med Care 2022; 60:504-511. [PMID: 35679174 PMCID: PMC9186448 DOI: 10.1097/mlr.0000000000001727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Research on US health systems has focused on large systems with at least 50 physicians. Little is known about small systems. OBJECTIVES Compare the characteristics, quality, and costs of care between small and large health systems. RESEARCH DESIGN Retrospective, repeated cross-sectional analysis. SUBJECTS Between 468 and 479 large health systems, and between 608 and 641 small systems serving fee-for-service Medicare beneficiaries, yearly between 2013 and 2017. MEASURES We compared organizational, provider and beneficiary characteristics of large and small systems, and their geographic distribution, using multiple Medicare and Internal Revenue Service administrative data sources. We used mixed-effects regression models to estimate differences between small and large systems in claims-based Healthcare Effectiveness Data and Information Set (HEDIS) quality measures and HealthPartners' Total Cost of Care measure using a 100% sample of Medicare fee-for-service claims. We fit linear spline models to examine the relationship between the number of a system's affiliated physicians and its quality and costs. RESULTS The number of both small and large systems increased from 2013 to 2017. Small systems had a larger share of practice sites (43.1% vs. 11.7% for large systems in 2017) and beneficiaries (51.4% vs. 15.5% for large systems in 2017) in rural areas or small towns. Quality performance was lower among small systems than large systems (-0.52 SDs of a composite quality measure) and increased with system size up to ∼75 physicians. There was no difference in total costs of care. CONCLUSIONS Small systems are a growing source of care for rural Medicare populations, but their quality performance lags behind large systems. Future studies should examine the mechanisms responsible for quality differences.
Collapse
Affiliation(s)
| | | | | | | | | | | | - José J. Escarce
- David Geffen School of Medicine at UCLA and UCLA Fielding School of Public Health, Los Angeles, CA
| |
Collapse
|
9
|
Neifert SN, Cho LD, Gal JS, Martini ML, Shuman WH, Chapman EK, Monterey M, Oermann EK, Caridi JM. Neurosurgical Performance in the First 2 Years of Merit-Based Incentive Payment System: A Descriptive Analysis and Predictors of Receiving Bonus Payments. Neurosurgery 2022; 91:87-92. [PMID: 35343468 DOI: 10.1227/neu.0000000000001927] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/08/2022] [Indexed: 11/19/2022] Open
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.
Collapse
Affiliation(s)
- Sean N Neifert
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA
| | - Logan D Cho
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jonathan S Gal
- Department of Anesthesiology, Perioperative and Pain Medicine, Mount Sinai Health System, New York, New York, USA
| | - Michael L Martini
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - William H Shuman
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Emily K Chapman
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michael Monterey
- Department of Neurosurgery, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Eric K Oermann
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA
| | - John M Caridi
- Department of Neurosurgery, University of Texas Health Science Center at Houston, Houston, Texas, USA
| |
Collapse
|
10
|
Qi AC, Joynt Maddox KE, Bierut LJ, Johnston KJ. Comparison of Performance of Psychiatrists vs Other Outpatient Physicians in the 2020 US Medicare Merit-Based Incentive Payment System. JAMA HEALTH FORUM 2022; 3:e220212. [PMID: 35977292 PMCID: PMC8956979 DOI: 10.1001/jamahealthforum.2022.0212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/19/2022] [Indexed: 01/03/2023] Open
Abstract
Question How did psychiatrists perform in the 2020 Medicare Merit-Based Incentive Payment System (MIPS) compared with other outpatient physicians? Findings In this cross-sectional study of 9356 psychiatrists and 196 306 other outpatient physicians participating in the 2020 MIPS, psychiatrists had significantly lower performance scores, were significantly more likely to be assessed a performance penalty, and were less likely to be assessed a bonus than other physicians. Meaning Psychiatrists performed worse than other physicians in Medicare’s new mandatory outpatient value-based payment system; therefore, more research is needed to evaluate the appropriateness of MIPS measures for psychiatrists. Importance Medicare’s Merit-Based Incentive Payment System (MIPS) is a new, mandatory, outpatient value-based payment program that ties reimbursement to performance on cost and quality measures for many US clinicians. However, it is currently unknown how the program measures the performance of psychiatrists, who often treat a different patient case mix with different clinical considerations than do other outpatient clinicians. Objective To compare performance scores and value-based reimbursement for psychiatrists vs other outpatient physicians in the 2020 MIPS. Design, Setting, and Participants In this cross-sectional study, the Centers for Medicare & Medicaid Services Provider Data Catalog was used to identify outpatient Medicare physicians listed in the National Downloadable File between January 1, 2018, and December 31, 2020, who participated in the 2020 MIPS and received a publicly reported final performance score. Data from the 593 863 clinicians participating in the 2020 MIPS were used to compare differences in the 2020 MIPS performance scores and value-based reimbursement (based on performance in 2018) for psychiatrists vs other physicians, adjusting for physician, patient, and practice area characteristics. Exposures Participation in MIPS. Main Outcomes and Measures Primary outcomes were final MIPS performance score and negative (penalty), positive, and exceptional performance bonus payment adjustments. Secondary outcomes were scores in the MIPS performance domains: quality, promoting interoperability, improvement activities, and cost. Results This study included 9356 psychiatrists (3407 [36.4%] female and 5 949 [63.6%] male) and 196 306 other outpatient physicians (69 221 [35.3%] female and 127 085 [64.7%] male) (data on age and race are not available). Compared with other physicians, psychiatrists were less likely to be affiliated with a safety-net hospital (2119 [22.6%] vs 64 997 [33.1%]) or a major teaching hospital (2148 [23.0%] vs 53 321 [27.2%]) and had lower annual Medicare patient volume (181 vs 437 patients) and mean patient risk scores (1.65 vs 1.78) (P < .001 for all). The mean final MIPS performance score for psychiatrists was 84.0 vs 89.7 for other physicians (absolute difference, −5.7; 95% CI, −6.2 to −5.2). A total of 573 psychiatrists (6.1%) received a penalty vs 5739 (2.9%) of other physicians (absolute difference, 3.2%; 95% CI, 2.8%-3.6%); 8664 psychiatrists (92.6%) vs 189 037 other physicians (96.3%) received a positive payment adjustment (absolute difference, −3.7%; 95% CI, −3.3% to −4.1%), and 7672 psychiatrists (82.0%) vs 174 040 other physicians (88.7%) received a bonus payment adjustment (absolute difference, −6.7%; 95% CI, −6.0% to −7.3%). These differences remained significant after adjustment. Conclusions and Relevance In this cross-sectional study that compared US psychiatrists with other outpatient physicians, psychiatrists had significantly lower 2020 MIPS performance scores, were penalized more frequently, and received fewer bonuses. Policy makers should evaluate whether current MIPS performance measures appropriately assess the performance of psychiatrists.
Collapse
Affiliation(s)
- Andrew C. Qi
- Department of Medicine, Washington University School of Medicine, St Louis, Missouri
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Karen E. Joynt Maddox
- Department of Medicine, Washington University School of Medicine, St Louis, Missouri
| | - Laura J. Bierut
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | - Kenton J. Johnston
- Department of Health Management and Policy, College for Public Health and Social Justice, St Louis University, St Louis, Missouri
| |
Collapse
|
11
|
Cha E, Mathis NJ, Joshi H, Sharma S, Zinovoy M, Ru M, Cahlon O, Gillespie EF, Marshall DC. Bias in Patient Experience Scores in Radiation Oncology: A Multicenter Retrospective Analysis. J Am Coll Radiol 2022; 19:542-551. [PMID: 35247326 PMCID: PMC9017791 DOI: 10.1016/j.jacr.2022.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 01/05/2022] [Accepted: 01/09/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Patient experience scores are increasingly important in measuring quality of care and determining reimbursement from payers, including the Hospital Value-Based Purchasing Program and the Radiation Oncology Model. However, the role of bias in patient experience scores in oncology is unknown, raising the possibility that such payment structures may inadvertently perpetuate bias in reimbursement. Therefore, the authors characterized patient-, physician-, and practice-level predictors of patient experience scores in patients undergoing radiation therapy. METHODS The authors retrospectively reviewed patient experience surveys for radiation oncology patients treated at two large multisite academic cancer centers. The outcome was responses on four survey questions. Covariates included self-reported patient demographics, physician characteristics, practice setting characteristics, and wait-time rating linked to each survey. Multivariable ordinal regression models were fitted to identify predictors of receiving a higher score on each of the survey questions. RESULTS In total, 2,868 patients completed surveys and were included in the analysis. Patient experience scores were generally high, with >90% of respondents answering 5 of 5 on the four survey items. Physician gender was not associated with any measured patient experience outcomes (P > 0.40 for all). Independent predictors of higher score included a wait-time experience classified as "good" as compared with "not good" (q < .001 for all). CONCLUSIONS Oncology practices aiming to improve patient experience scores may wish to focus their attention on improving wait times for patients. Although a difference in patient experience scores on the basis of physician gender was not observed, such bias is likely to be complex, and further research is needed to characterize its effects.
Collapse
Affiliation(s)
- Elaine Cha
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Noah J Mathis
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Himanshu Joshi
- Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York; Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sonam Sharma
- Assistant Program Director, Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Melissa Zinovoy
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Meng Ru
- Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Oren Cahlon
- Deputy Physician-in-Chief for Strategic Partnerships and Vice Chair, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Erin F Gillespie
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Deborah C Marshall
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York.
| |
Collapse
|
12
|
Gettel CJ, Han CR, Canavan ME, Bernheim SM, Drye EE, Duseja R, Venkatesh AK. The 2018 Merit-based Incentive Payment System: Participation, Performance, and Payment Across Specialties. Med Care 2022; 60:156-163. [PMID: 35030565 PMCID: PMC8820355 DOI: 10.1097/mlr.0000000000001674] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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.
Collapse
Affiliation(s)
- Cameron J. Gettel
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
- National Clinician Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | | | - Maureen E. Canavan
- Department of Internal Medicine, Cancer Outcomes and Public Policy and Effectiveness Research (COPPER), Yale School of Medicine, New Haven, CT, USA
| | - Susannah M. Bernheim
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven CT, USA
- Section of General Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Elizabeth E. Drye
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven CT, USA
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Reena Duseja
- Office of Management and Budget, Washington D.C., USA
| | - Arjun K. Venkatesh
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven CT, USA
| |
Collapse
|
13
|
Cwalina TB, Jella TK, Acuña AJ, Samuel LT, Kamath AF. How Did Orthopaedic Surgeons Perform in the 2018 Centers for Medicaid & Medicare Services Merit-based Incentive Payment System? Clin Orthop Relat Res 2022; 480:8-22. [PMID: 34543249 PMCID: PMC8673991 DOI: 10.1097/corr.0000000000001981] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/27/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND The Merit-based Incentive Payment System (MIPS) is the latest value-based payment program implemented by the Centers for Medicare & Medicaid Services. As performance-based bonuses and penalties continue to rise in magnitude, it is essential to evaluate this program's ability to achieve its core objectives of quality improvement, cost reduction, and competition around clinically meaningful outcomes. QUESTIONS/PURPOSES We asked the following: (1) How do orthopaedic surgeons differ on the MIPS compared with surgeons in other specialties, both in terms of the MIPS scores and bonuses that derive from them? (2) What features of surgeons and practices are associated with receiving penalties based on the MIPS? (3) What features of surgeons and practices are associated with receiving a perfect score of 100 based on the MIPS? METHODS Scores from the 2018 MIPS reporting period were linked to physician demographic and practice-based information using the Medicare Part B Provider Utilization and Payment File, the National Plan and Provider Enumeration System Data (NPPES), and National Physician Compare Database. For all orthopaedic surgeons identified within the Physician Compare Database, there were 15,210 MIPS scores identified, representing a 72% (15,210 of 21,124) participation rate in the 2018 MIPS. Those participating in the MIPS receive a final score (0 to 100, with 100 being a perfect score) based on a weighted calculation of performance metrics across four domains: quality, promoting interoperability, improvement activities, and costs. In 2018, orthopaedic surgeons had an overall mean ± SD score of 87 ± 21. From these scores, payment adjustments are determined in the following manner: scores less than 15 received a maximum penalty adjustment of -5% ("penalty"), scores equal to 15 did not receive an adjustment ("neutral"), scores between 15 and 70 received a positive adjustment ("positive"), and scores above 70 (maximum 100) received both a positive adjustment and an additional exceptional performance adjustment with a maximum adjustment of +5% ("bonus"). Adjustments among orthopaedic surgeons were compared across various demographic and practice characteristics. Both the mean MIPS score and the resulting payment adjustments were compared with a group of surgeons in other subspecialties. Finally, multivariable logistic regression models were generated to identify which variables were associated with increased odds of receiving a penalty as well as a perfect score of 100. RESULTS Compared with surgeons in other specialties, orthopaedic surgeons' mean MIPS score was 4.8 (95% CI 4.3 to 5.2; p < 0.001) points lower. From this difference, a lower proportion of orthopaedic surgeons received bonuses (-5.0% [95% CI -5.6 to -4.3]; p < 0.001), and a greater proportion received penalties (+0.5% [95% CI 0.2 to 0.8]; p < 0.001) and positive adjustments (+4.6% [95% CI 6.1 to 10.7]; p < 0.001) compared with surgeons in other specialties. After controlling for potentially confounding variables such as gender, years in practice, and practice setting, small (1 to 49 members) group size (adjusted odds ratio 22.2 [95% CI 8.17 to 60.3]; p < 0.001) and higher Hierarchical Condition Category (HCC) scores (aOR 2.32 [95% CI 1.35 to 4.01]; p = 0.002) were associated with increased odds of a penalty. Also, after controlling for potential confounding, we found that reporting through an alternative payment model (aOR 28.7 [95% CI 24.0 to 34.3]; p < 0.001) was associated with increased odds of a perfect score, whereas small practice size (1 to 49 members) (aOR 0.35 [95% CI 0.31 to 0.39]; p < 0.001), a high patient volume (greater than 500 Medicare patients) (aOR 0.82 [95% CI 0.70 to 0.95]; p = 0.01), and higher HCC score (aOR 0.79 [95% Cl 0.66 to 0.93]; p = 0.006) were associated with decreased odds of a perfect MIPS score. CONCLUSION Collectively, orthopaedic surgeons performed well in the second year of the MIPS, with 87% earning bonus payments. Among participating orthopaedic surgeons, individual reporting affiliation, small practice size, and more medically complex patient populations were associated with higher odds of receiving penalties and lower odds of earning a perfect score. Based on these findings, we recommend that individuals and orthopaedic surgeons in small group practices strive to forge partnerships with larger hospital practices with adequate ancillary staff to support quality reporting initiatives. Such partnerships may help relieve surgeons of growing administrative obligations and allow for maintained focus on direct patient care activities. Policymakers should aim to produce a shortened panel of performance measures to ensure more standardized comparison and less time and energy diverted from established clinical workflows. The current MIPS scoring methodology should also be amended with a complexity modifier to ensure fair evaluation of surgeons practicing in the safety net setting, or those treating patients with a high comorbidity burden. LEVEL OF EVIDENCE Level III, therapeutic study.
Collapse
Affiliation(s)
- Thomas B. Cwalina
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Tarun K. Jella
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Alexander J. Acuña
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Linsen T. Samuel
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Atul F. Kamath
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| |
Collapse
|
14
|
Gettel CJ, Han CR, Granovsky MA, Berdahl CT, Kocher KE, Mehrotra A, Schuur JD, Aldeen AZ, Griffey RT, Venkatesh AK. Emergency clinician participation and performance in the Centers for Medicare & Medicaid Services Merit-based Incentive Payment System. Acad Emerg Med 2022; 29:64-72. [PMID: 34375479 PMCID: PMC8766873 DOI: 10.1111/acem.14373] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/25/2021] [Accepted: 06/30/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND The Merit-based Incentive Payment System (MIPS) is the largest national pay-for-performance program and the first to afford emergency clinicians unique financial incentives for quality measurement and improvement. With little known regarding its impact on emergency clinicians, we sought to describe participation in the MIPS and examine differences in performance scores and payment adjustments based on reporting affiliation and reporting strategy. METHODS We performed a cross-sectional analysis using the Centers for Medicare & Medicaid Services 2018 Quality Payment Program (QPP) Experience Report data set. We categorized emergency clinicians by their reporting affiliation (individual, group, MIPS alternative payment model [APM]), MIPS performance scores, and Medicare Part B payment adjustments. We calculated performance scores for common quality measures contributing to the quality category score if reported through qualified clinical data registries (QCDRs) or claims-based reporting strategies. RESULTS In 2018, a total of 59,828 emergency clinicians participated in the MIPS-1,246 (2.1%) reported as individuals, 43,404 (72.5%) reported as groups, and 15,178 (25.4%) reported within MIPS APMs. Clinicians reporting as individuals earned lower overall MIPS scores (median [interquartile range {IQR}] = 30.8 [15.0-48.2] points) than those reporting within groups (median [IQR] = 88.4 [49.3-100.0]) and MIPS APMs (median [IQR] = 100.0 [100.0-100.0]; p < 0.001) and more frequently incurred penalties with a negative payment adjustment. Emergency clinicians had higher measure scores if reporting QCDR or QPP non-emergency medicine specialty set measures. CONCLUSIONS Emergency clinician participation in national value-based programs is common, with one in four participating through MIPS APMs. Those employing specific strategies such as QCDR and group reporting received the highest MIPS scores and payment adjustments, emphasizing the role that reporting strategy and affiliation play in the quality of care.
Collapse
Affiliation(s)
- Cameron J. Gettel
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
- National Clinician Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | | | | | - Carl T. Berdahl
- Departments of Medicine and Emergency Medicine, Cedars-Sinai Medical Center, West Hollywood, CA, USA
| | - Keith E. Kocher
- Department of Emergency Medicine, School of Medicine, University of Michigan, Ann Arbor, MI, USA
- Department of Learning Health Sciences, School of Medicine, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Abhishek Mehrotra
- Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Jeremiah D. Schuur
- Department of Emergency Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Richard T. Griffey
- Department of Emergency Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Arjun K. Venkatesh
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven CT, USA
| |
Collapse
|
15
|
Khullar D, Bond AM, Qian Y, O'Donnell E, Gans DN, Casalino LP. Physician Practice Leaders' Perceptions of Medicare's Merit-Based Incentive Payment System (MIPS). J Gen Intern Med 2021; 36:3752-3758. [PMID: 33835310 PMCID: PMC8034038 DOI: 10.1007/s11606-021-06758-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 03/23/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Medicare's Merit-based Incentive Payment System (MIPS) is a major value-based purchasing program. Little is known about how physician practice leaders view the program and its benefits and challenges. OBJECTIVE To understand practice leaders' perceptions of MIPS. DESIGN AND PARTICIPANTS Interviews were conducted from December 12, 2019, to June 23, 2020, with leaders of 30 physician practices of various sizes and specialties across the USA. Practices were randomly selected using the Medical Group Management Association's membership database. Practices included small primary care and general surgery practices (1-9 physicians); medium primary care and general surgery practices (10-25 physicians); and large multispecialty practices (50 or more physicians). Participants were asked about their perceptions of MIPS measures; the program's effect on patient care; administrative burden; and rationale for participation. MAIN MEASURES Major themes related to practice participation in MIPS. KEY RESULTS Interviews were conducted with 30 practices representing all US census regions. Six major themes emerged: (1) MIPS is understood as a continuation of previous value-based payment programs and a precursor to future programs; (2) measures are more relevant to primary care practices than other specialties; (3) leaders are conflicted on whether the program improves patient care; (4) MIPS creates a substantial administrative burden, exacerbated by annual programmatic changes; (5) incentives are small relative to the effort needed to participate; and (6) external support for participation can be helpful. Many participants indicated that their practice only participated in MIPS to avoid financial penalties; some reported that physicians cared for fewer patients due to the program's administrative burden. CONCLUSIONS Practice leaders reported several challenges related to MIPS, including irrelevant measures, administrative burden, frequent programmatic changes, and small incentives. They held mixed views on whether the program improves patient care. These findings may be useful to policymakers hoping to improve MIPS.
Collapse
Affiliation(s)
- Dhruv Khullar
- Division of Health Policy and Economics, Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA.
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
| | - Amelia M Bond
- Division of Health Policy and Economics, Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Yuting Qian
- Division of Health Policy and Economics, Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Eloise O'Donnell
- Division of Health Policy and Economics, Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - David N Gans
- Medical Group Management Association, Englewood, CO, USA
| | - Lawrence P Casalino
- Division of Health Policy and Economics, Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| |
Collapse
|
16
|
Gal JS, Morewood GH, Mueller JT, Popovich MT, Caridi JM, Neifert SN. Anesthesia provider performance in the first two years of merit-based incentive payment system: Shifts in reporting and predictors of receiving bonus payments. J Clin Anesth 2021; 76:110582. [PMID: 34775348 DOI: 10.1016/j.jclinane.2021.110582] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/01/2021] [Accepted: 11/03/2021] [Indexed: 10/19/2022]
Abstract
STUDY OBJECTIVE The Merit-Based Incentive Payment System (MIPS) program was intended to align CMS quality and incentive programs. To date, no reports have described anesthesia clinician performance in the first two years of the program. DESIGN Observational retrospective cohort study. SETTING Centers for Medicare and Medicaid Services public datasets for their Quality Payment Program. PATIENTS Anesthesia clinicians who participated in MIPS for 2017 and 2018 performance years. INTERVENTIONS Descriptive statistics compared anesthesia clinician characteristics, practice setting, and MIPS performance between the two years to determine associations with MIPS-based payment adjustments. MEASUREMENTS Logistic regression identified independent predictors of bonus payments for exceptional performance. MAIN RESULTS Compared with participants in 2017 (n = 25,604), participants in 2018 (n = 54,381) had a higher proportion of reporting through groups and alternative payment models (APMs) than as individuals (p < 0.001). The proportion of clinicians earning performance bonuses increased from 2017 to 2018 except for those MIPS participants reporting as individuals. Median total MIPS scores were higher in 2018 than 2017 (84.6 vs. 82.4, p < 0.001), although median total scores fell for participants reporting as individuals (40.9 vs 75.5, p < 0.001). Among clinicians with scores in both years (n = 20,490), 10,559 (51.3%) improved their total score between 2017 and 2018, and 347 (1.7%) changed reporting from individual to APM. Reporting as an individual compared with group reporting (OR: 0.75; 95% CI: 0.71 to 0.80; p < 0.001) was associated with lower rates of bonus payments, as was having a greater proportion of patients dual-eligible for Medicaid and Medicare. Reporting through an APM (OR: 149.6; 95% CI: 110 to 203.4; p < 0.001) and increasing practice group size were associated with higher likelihood of bonus payments. CONCLUSIONS Anesthesia clinician MIPS participation and performance were strong during 2017 and 2018 performance years. Providers who reported through groups or APMs have a higher likelihood of receiving bonus payments.
Collapse
Affiliation(s)
- Jonathan S Gal
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| | - Gordon H Morewood
- Department of Anesthesiology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19102, USA.
| | - Jeffrey T Mueller
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Phoenix, AZ 85054, USA.
| | - Matthew T Popovich
- Quality and Regulatory Affairs, American Society of Anesthesiologists, Washington, DC 20006, USA.
| | - John M Caridi
- Department of Neurosurgery, University of Texas Health Science Center at Houston, Houston, TX 77030, USA.
| | - Sean N Neifert
- Department of Neurosurgery, NYU Langone Health, New York, NY 10016, USA.
| |
Collapse
|
17
|
Tummalapalli SL, Mendu ML, Struthers SA, White DL, Bieber SD, Weiner DE, Ibrahim SA. Nephrologist Performance in the Merit-Based Incentive Payment System. Kidney Med 2021; 3:816-826.e1. [PMID: 34693261 PMCID: PMC8515074 DOI: 10.1016/j.xkme.2021.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
RATIONALE & OBJECTIVE The Merit-Based Incentive Payment System (MIPS) is the largest quality payment program administered by the Centers for Medicare & Medicaid Services. Little is known about predictors of nephrologist performance in MIPS. STUDY DESIGN Cross-sectional analysis. SETTING & PARTICIPANTS Nephrologists participating in MIPS in performance year 2018. PREDICTORS Nephrologist characteristics: (1) participation type (individual, group, or MIPS alternative payment model [APM]), (2) practice size, (3) practice setting (rural, Health Professional Shortage Area [HPSA], or hospital based), and (4) geography (Census Division). OUTCOMES MIPS Final, Quality, Promoting Interoperability, Improvement Activities, and Cost scores. Using published consensus ratings, we also examined the validity of MIPS Quality measures selected by nephrologists. ANALYTICAL APPROACH Unadjusted and multivariable-adjusted linear regression models assessing the associations between nephrologist characteristics and MIPS Final scores. RESULTS Among 6,117 nephrologists participating in MIPS in 2018, the median MIPS Final score was 100 (interquartile range, 94-100). In multivariable-adjusted analyses, MIPS APM participation was associated with a 12.5-point (95% CI, 10.6-14.4) higher score compared with individual participation. Nephrologists in large (355-4,294 members) and medium (15-354 members) practices scored higher than those in small practices (1-14 members). In analyses adjusted for practice size, practice setting, and geography, among individual and group participants, HPSA nephrologists scored 1.9 (95% CI, -3.6 to -0.1) points lower than non-HPSA nephrologists, and hospital-based nephrologists scored 6.0 (95% CI, -8.3 to -3.7) points lower than non-hospital-based nephrologists. The most frequently reported quality measures by individual and group participants had medium to high validity and were relevant to nephrology care, whereas MIPS APM measures had little relevance to nephrology. LIMITATIONS Lack of adjustment for patient characteristics. CONCLUSIONS MIPS APM participation, larger practice size, non-HPSA setting, and non-hospital-based setting were associated with higher MIPS scores among nephrologists. Our results inform strategies to improve MIPS program design and generate meaningful distinctions between practices that will drive improvements in care.
Collapse
Affiliation(s)
- Sri Lekha Tummalapalli
- Division of Healthcare Delivery Science & Innovation, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
| | - Mallika L. Mendu
- Division of Renal Medicine, Brigham and Women’s Hospital, Harvard Medical School
- Center for Population Health, Mass General Brigham, Boston, MA
| | - Sarah A. Struthers
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA
| | | | | | - Daniel E. Weiner
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA
| | - Said A. Ibrahim
- Division of Healthcare Delivery Science & Innovation, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
| |
Collapse
|
18
|
Riaz S, Erickson KF. Early Nephrologist Performance in the Merit-Based Incentive Payment System: Both Reassurance and Reason for Concern. Kidney Med 2021; 3:699-701. [PMID: 34693251 PMCID: PMC8515087 DOI: 10.1016/j.xkme.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Sohail Riaz
- Section of Nephrology, Baylor College of Medicine
| | - Kevin F. Erickson
- Section of Nephrology, Baylor College of Medicine
- Baker Institute for Public Policy, Rice University, Houston TX
| |
Collapse
|
19
|
Byrd JN, Chung KC. Evaluation of the Merit-Based Incentive Payment System and Surgeons Caring for Patients at High Social Risk. JAMA Surg 2021; 156:1018-1024. [PMID: 34379100 DOI: 10.1001/jamasurg.2021.3746] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Importance The latest step in the Centers for Medicaid & Medicare transformation to pay-for-value is the Medicare Merit-Based Incentive Payment System (MIPS). Value-based payment designs often do not account for uncaptured clinical status and social determinants of health in patients at high social risk, and the consequences for clinicians and patients associated with their use have not been explored. Objective To evaluate MIPS scoring of surgeons caring for patients at high social risk to determine whether this implementation threatens disadvantaged patients' access to surgical care. Design, Setting, and Participants A retrospective cohort study of US general surgeons participating in MIPS during its first year in outpatient surgical practices across the US and territories. The study was conducted from September 1, 2020, to May 1, 2021. Data were analyzed from November 1, 2020, to March 30, 2021 (although data were collected during the 2017 calendar year and reported ahead of 2019 payment adjustments). Main Outcomes and Measures Characteristics of surgeons participating in MIPS, overall MIPS score assigned to clinician. and practice-level disadvantage measures. The MIPS scores can range from 0 to 100. For the first year, a score of less than 3 led to negative payment adjustment; a score of greater than 3 but less than 70 to a positive adjustment; and a score of 70 or higher to the exceptional performance bonus. Results Of 20 593 general surgeons, 10 252 participated in the first year of MIPS. Surgeons with complete patient data (n = 9867) were evaluated and a wide range of dual-eligible patient caseloads from 0% to 96% (mean [SD], 27.1% [14.5%]) was identified. Surgeons in the highest quintile of dual eligibility cared for a Medicare patient caseload ranging from 37% to 96% dual eligible for Medicare and Medicaid. Surgeons caring for the patients at highest social risk had the lowest final mean (SD) MIPS score compared with the surgeons caring for the patients at least social risk (66.8 [37.3] vs 71.2 [35.9]; P < .001). Conclusions and Relevance Results of this cohort study suggest that implementation of MIPS value-based care reimbursement without adjustment for caseload of patients at high social risk may penalize surgeons who care for patients at highest social risk.
Collapse
Affiliation(s)
- Jacqueline N Byrd
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor.,Department of Surgery, The University of Texas Southwestern Medical School, Dallas
| | - Kevin C Chung
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor
| |
Collapse
|
20
|
Miller LE, Kondamuri NS, Xiao R, Rathi VK. Otolaryngologist Performance in the Merit-Based Incentive Payment System in 2018. Otolaryngol Head Neck Surg 2021; 166:858-861. [PMID: 34314266 DOI: 10.1177/01945998211032896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In 2017, the Centers for Medicare and Medicaid Services transitioned clinicians to the Merit-Based Incentive Payment System (MIPS), the largest mandatory pay-for-performance program in health care history. The first full MIPS program year was 2018, during which the Centers for Medicare and Medicaid Services raised participation requirements and performance thresholds. Using publicly available Medicare data, we conducted a retrospective cross-sectional analysis of otolaryngologist participation and performance in the MIPS in 2017 and 2018. In 2018, otolaryngologists reporting as individuals were less likely (P < .001) to earn positive payment adjustments (n = 1076/1584, 67.9%) than those participating as groups (n = 2802/2804, 99.9%) or in alternative payment models (n = 1705/1705, 100.0%). Approximately one-third (n = 1286/4472, 28.8%) of otolaryngologists changed reporting affiliations between 2017 and 2018. Otolaryngologists who transitioned from reporting as individuals to participating in alternative payment models (n = 137, 3.1%) achieved the greatest performance score improvements (median change, +23.4 points; interquartile range, 12.0-65.5). These findings have important implications for solo and independent otolaryngology practices in the era of value-based care.
Collapse
Affiliation(s)
- Lauren E Miller
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Neil S Kondamuri
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Roy Xiao
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Vinay K Rathi
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
21
|
Forbes N, Chau M, Koury HF, Lethebe BC, Smith ZL, Wani S, Keswani RN, Elmunzer BJ, Anderson JT, Heitman SJ, Hilsden RJ. Development and validation of a patient-reported scale for tolerability of endoscopic procedures using conscious sedation. Gastrointest Endosc 2021; 94:103-110.e2. [PMID: 33385464 PMCID: PMC8761529 DOI: 10.1016/j.gie.2020.12.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/18/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Patient-reported experience measures (PREMs) assessing the tolerability of endoscopic procedures are scarce. In this study, we designed and validated a PREM to assess tolerability of endoscopy using conscious sedation. METHODS The patient-reported scale for tolerability of endoscopic procedures (PRO-STEP) consists of questions within 2 domains and is administered to outpatients at discharge from the endoscopy unit. Domain 1 (intraprocedural) consists of 2 questions regarding discomfort/pain and awareness, whereas domain 2 (postprocedural) consists of 4 questions on pain, nausea, distention, and either throat or anal pain. All questions are scored on a Likert scale from 0 to 10. Cronbach's alpha was used to measure internal consistency of the questions. Multivariable logistic regression was performed to assess predictors of higher scores, reported using adjusted odds ratios and confidence intervals. RESULTS Two hundred fifty-five patients (91 colonoscopy, 73 gastroscopy, and 91 ERCP) were included. Colonoscopy was the least tolerable procedure by recall, with mean intraprocedural awareness and discomfort scores of 5.1 ± 3.8, and 2.6 ± 2.7, respectively. Consistency between intraprocedural awareness and discomfort/pain yielded an acceptable Cronbach's alpha of .71 (95% confidence interval, .62-.78). Higher use of midazolam during colonoscopy was inversely associated with an intraprocedural awareness score of 7 or higher (per additional mg: adjusted odds ratio, .23; 95% confidence interval, .09-.54). CONCLUSIONS PRO-STEP is a simple PREM that can be administered after multiple endoscopic procedures using conscious sedation. Future work should focus on its performance characteristics in adverse event prediction.
Collapse
Affiliation(s)
- Nauzer Forbes
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Millie Chau
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
| | - Hannah F. Koury
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - B. Cord Lethebe
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Zachary L. Smith
- Department of Medicine, Division of Gastroenterology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Sachin Wani
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Denver, Colorado, USA
| | - Rajesh N. Keswani
- Division of Gastroenterology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - B. Joseph Elmunzer
- Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - John T. Anderson
- Department of Gastroenterology, Gloucestershire Hospitals NHSFT, Gloucester, UK
| | - Steven J. Heitman
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Robert J. Hilsden
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
22
|
Affiliation(s)
- Vinay K Rathi
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston
| |
Collapse
|
23
|
Johnston KJ, Hockenberry JM, Joynt Maddox KE. Physician Performance in the Medicare Merit-based Incentive Payment System-Reply. JAMA 2021; 325:309. [PMID: 33464333 DOI: 10.1001/jama.2020.22810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Kenton J Johnston
- Department of Health Management and Policy, Saint Louis University, St Louis, Missouri
| | - Jason M Hockenberry
- Department of Health Policy and Management, Emory University, Atlanta, Georgia
| | - Karen E Joynt Maddox
- Washington University Center for Health Economics and Policy, Washington University School of Medicine, St Louis, Missouri
- Associate Editor, JAMA
| |
Collapse
|
24
|
Himmelstein DU, Woolhandler S. Health Care Crisis Unabated: A Review of Recent Data on Health Care in the United States. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2020; 51:182-187. [PMID: 33334224 DOI: 10.1177/0020731420981497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We review recently published studies of US health policy and the nation's health care system. Even prior to the COVID-19 pandemic, health inequalities were widening and care was inequitably distributed. Although the Affordable Care Act's coverage expansion improved access to care and timely cancer diagnoses, a large proportion of US residents continued to avoid medical care due to concerns about costs, and access to mental health services remains particularly inadequate. Yet more evidence of private insurers' profit-driven misbehaviors and of corruption among medical leaders continues to emerge. Misguided incentives and lax regulation encourages nominally nonprofit health care providers to mimic for-profits' misconduct, and rapacious investors own and control an increasing share of physicians' practices. Pharmaceutical firms wield outsize political influence and devote far more funds to rewarding investors than to research and development effort. Yet despite vigorous efforts by pharma and other commercial interests to denigrate national health insurance, polls indicate that the COVID-19 pandemic has led to increasing support for such reform.
Collapse
Affiliation(s)
- David U Himmelstein
- School of Urban Public Health, City University of New York at Hunter College, New York, NY, USA
| | - Steffie Woolhandler
- School of Urban Public Health, City University of New York at Hunter College, New York, NY, USA
| |
Collapse
|
25
|
Rathi VK, McWilliams JM, Khullar D. Preserving and Promoting Competition in the Post–Coronavirus Disease 2019 Healthcare Delivery System. JAMA HEALTH FORUM 2020; 1:e201191. [DOI: 10.1001/jamahealthforum.2020.1191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Vinay K. Rathi
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston
| | - J. Michael McWilliams
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
- Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, Massachusetts
- USC Schaeffer Center for Health Economics and Policy, Los Angeles, California
| | - Dhruv Khullar
- Division of Health Policy and Economics, Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| |
Collapse
|