By OPEN MINDS Circle
The Medicare Merit-based Incentive Payment System (MIPS) unfairly penalizes primary care physicians caring for consumer populations with more complex medical needs. In 2019, MIPS scores for primary care physicians were inconsistently associated with their performance on process and outcome measures. Primary care physicians delivering high quality care were more likely to receive low MIPS scores if they served a higher-than-average percentage of medically complex and/or socially at-risk consumers.
The inconsistency was noted in a comparison involving 3.4 million consumers attributed to 80,246 primary care physicians. The comparison focused on the physician MIPS scores and performance on five unadjusted process measures, six adjusted outcome measures, and a composite outcome measure. About 5.9% of the physicians had low MIPS scores, which was defined as 30 or lower. About 7.7% had medium MIPS scores ranging from 30 to 75. The remaining 86.4% had high MIPS scores exceeding 75.
About 19% of physicians with low MIPS scores had composite outcomes performance in the top quintile. About 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 consumer, compared with physicians with low MIPS scores and poor outcomes.
Compared with physicians with high MIPS scores, physicians with low MIPS scores had significantly worse mean performance on three of the five process measures:
- For diabetic eye examinations, the MIPS scores were 56.1% for physicians with high MIPS scores compared to 63.2% for physicians with low MIPS scores.
- For diabetic HbA1c screening, the MIPS scores were 84.6% for physicians with high MIPS scores compared to 89.4% for physicians with low MIPS scores.
- For mammography screening, the MIPS scores were 58.2% for physicians with high MIPS scores compared to 70.4% for physicians with low MIPS scores.
- For influenza vaccination, the MIPS scores were 78.0% for physicians with high MIPS scores compared to 76.8% for physicians with low MIPS scores.
- For tobacco screening, the MIPS scores were 95.0% for physicians with high MIPS scores compared to 94.1% for physicians with low MIPS scores.
MIPS scores were inconsistently associated with risk-adjusted consumer outcomes: compared with physicians with high MIPS scores, physicians with low MIPS scores had significantly better mean performance on one outcome and worse performance of another. Performance was not significantly different on four other ambulatory care-sensitive admission outcomes.
- Emergency department visits per 1,000 consumers were 307.6 for physicians with high MIPS scores vs 316.4 for physicians with low MIPS scores.
- All-cause hospitalizations per 1,000 consumers were 255.4 for physicians with high MIPS scores vs 225.2 for physicians with low MIPS scores.
These findings were reported in “Association Between Individual Primary Care Physician Merit-based Incentive Payment System Score and Measures of Process and Patient Outcomes” by Amelia M. Bond, Ph.D.; William L. Schpero, Ph.D.; Lawrence P. Casalino, M.D., Ph.D.; and colleagues. The researchers sought to assess whether higher MIPS scores for primary care physicians are associated with better performance on clinical process and consumer outcome measures. The analysis included data for 80,246 primary care physicians who participated in MIPS in 2019. The analysis focused on the association between physician MIPS scores and the physician’s performance on five unadjusted process measures, six adjusted outcome measures, and a composite outcome measure.
For more information, contact: Amelia M. Bond, Ph.D., Assistant Professor of Population Health Sciences, Division of Health Policy and Economics, Department of Population Health Sciences, Weill Cornell Medical College, 402 East 67th Street, New York, New York 10065; Email: amb2036@med.cornell.edu; Website: https://directory.med.cornell.edu/person/profile/amb2036