Brief ReportPhysician group performance in the first year of Medicare's Merit-based Incentive Payment System
Section snippets
Background
Through its Merit-based Incentive Payment System (MIPS) program, the Centers for Medicare and Medicaid Services (CMS) engages over 900,000 clinicians nationwide who care for Medicare fee-for-service beneficiaries. MIPS evaluates clinicians based on activities in four domains: quality, resource use, promoting interoperability (use of health information technology), and improvement activities.1,2 Performance in these domains is combined into a “composite performance score” (CPS), which is used to
Methods
We used publicly available 2017 Medicare data to obtain information about practice characteristics and MIPS performance.5,6 These data were used to calculate the following practice characteristics: size (number of clinicians), urban/rural status, geographic location, scope (single versus multi-specialty), population size, and case-mix beneficiaries' average Hierarchical Condition Category scores. We also used county-level data to define characteristics of practices’ surrounding communities:
Results
Our sample consisted of 22,659 practices representing 723,870 clinicians. Overall, 64.0% of practices received a positive adjustment, 0.6% received no adjustment, and 35.3% received a negative adjustment. The mean/median CPS was 44/40, with a large proportion of practices (8,006) receiving scores of 0 (Fig. 1, Panel A). Excluding these practices, the distribution of composite scores was left-skewed with mean/median of 68/80 (Fig. 1, Panel B).
Most practices were single-specialty groups (73.1%)
Discussion
To our knowledge, this is the first analysis of MIPS year 1 performance, and the first to describe performance among group practices. Our results pose two key policy and practice implications.
First, our analysis suggests that CMS achieved its goal of easing clinicians into MIPS under intentionally lenient performance targets in 2017.9 This point is underscored by the median score of 80 among eligible practices, which reflects not just positive payment adjustments but also exceptional
Declaration of competing interest
Dr. Liao reported textbook royalties and an honorarium from Wolters Kluwer and personal fees from Kaiser Permanente Washington Research Institute, none of which are related to this manuscript. Dr. Navathe reported receiving grants from Hawaii Medical Service Association, Anthem Public Policy Institute, Healthcare Research and Education Trust, Cigna, and Oscar Health; personal fees from Navvis Healthcare, Agathos, Inc., and the Medicare Payment Advisory Commission; personal fees and equity from
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