The Medicare Merit-Based Incentive Payment System (MIPS), designed to improve healthcare quality through pay adjustments for primary care physicians, may not be accurately assessing performance, according to a Weill Cornell Medicine study. This program, a key component of the Medicare Primary Care Incentive Payment Program, assigns scores to physicians based on various factors, impacting their reimbursement rates.
The study, published in the Journal of the American Medical Association (JAMA), analyzed data from over 80,000 primary care physicians participating in MIPS. Researchers evaluated performance based on quality, cost, electronic health record use, and clinical practice improvement activities. Surprisingly, they found a weak correlation between physician performance and MIPS scores, raising concerns about the effectiveness of the Medicare primary care incentive payment program.
Dr. Amelia Bond, lead author of the study.
MIPS, implemented in 2017, consolidated previous Medicare incentive programs and now encompasses nearly all eligible physicians. However, its accuracy in evaluating physician quality has been debated. This study provides a comprehensive analysis of this critical aspect of the Medicare primary care incentive payment program.
MIPS Scoring vs. Actual Performance in Primary Care
Researchers used Medicare datasets, including claims records from 2019, focusing on 80,246 primary care physicians and 3.4 million patients. While MIPS allows physicians to select six out of 257 performance measures, this study prioritized outcome-based measures relevant to primary care.
These measures encompassed annual diabetes blood tests, eye exams for diabetics, breast cancer screenings, flu vaccinations, emergency department visits, and hospital admissions for conditions like diabetes, COPD, and heart failure. The analysis revealed a disconnect between MIPS scores and performance based on these crucial indicators within the Medicare primary care incentive payment program.
For instance, low-scoring physicians performed worse on some process measures (diabetes blood tests, eye exams, mammography) but better on others (flu vaccination, tobacco screening). Regarding outcomes, low-scoring physicians showed better performance on emergency room visits but worse on all-cause hospitalizations. The remaining outcomes showed no significant difference.
Further highlighting the discrepancy, 19% of low-scoring physicians ranked in the top performance quintile, while 21% of high-scoring physicians fell into the lowest. This suggests that the Medicare primary care incentive payment program, through MIPS, may not accurately differentiate between high and low performers.
Potential Reasons for the Disconnect in the Medicare Primary Care Incentive Payment Program
Researchers suggest potential reasons for the misalignment between MIPS scores and actual performance within the Medicare primary care incentive payment program. Inadequate risk adjustment for physicians treating complex or socially vulnerable patients might disadvantage those providing high-quality care to challenging populations. Smaller practices may also lack resources for comprehensive quality reporting, impacting their MIPS scores. Essentially, the ability to navigate MIPS paperwork might be a stronger predictor of score than actual clinical performance.
Dr. Dhruv Khullar, senior author of the study
The study also revealed that physicians with high performance but low MIPS scores often treated sicker, lower-income patients. This raises concerns about financial penalties potentially affecting physicians dedicated to serving vulnerable populations within the Medicare primary care incentive payment program.
While researchers don’t anticipate MIPS elimination, they hope this study will drive improvements to the Medicare primary care incentive payment program. Ensuring accurate performance assessment is crucial for incentivizing quality care and fairly compensating physicians dedicated to improving patient outcomes.
