Does the Merit-Based Incentive Payment System Disproportionately Affect Safety-Net Practices?
Year: 2020
Type: article
Abstract: Three years since the introduction of the nationwide Merit-Based Incentive Payment System (MIPS), the US Centers for Medicare & Medicaid Services (CMS) continues using the program to incentivize clinicians to improve health care value for Medicare beneficiaries.The MIPS is a pay-for-performance program that increases payment rates for clinicians who provide high-value care, while penalizing clinicians who do not by decreasing their payment rates.The program's design has been largely similar since launching in 2017.As in earlier years, participating clinicians are evaluated on performance in the domains of (1) quality (as assessed through clinical quality measures), (2) improvement activities (initiatives that can improve care), (3) costs (patients' resource use and spending), and (4) promotion of interoperability (use of health information technology to improve care delivery).Performance in each domain is incorporated into an overall composite performance score that ultimately dictates whether clinicians receive upward, downward, or no payment rate adjustments.Aggregate 2017 and 2018 results from CMS suggest that most individual clinicians have fared well thus far in MIPS, with 93% to 98% receiving an upward payment adjustment.However, those data do not account for the fact that many clinicians participate in MIPS through group practices rather than as individuals and MIPS appeared to disproportionately penalize small and rural practices in 2017.Unfortunately, little is currently known about practice-level MIPS performance.In particular, it is unknown how safety-net practices (ie, those in which large proportions of care are provided to individuals with vulnerabilities) fared in MIPS.This dearth of knowledge is especially concerning given the history of safety-net practices being disproportionately penalized under other national Medicare payment reforms, such as the Hospital Readmissions Reduction Program and the Value-Based Purchasing Program.1,2 Safety-net practices may face more barriers and possess fewer strategies for responding to such programs if large proportions of their care are for patients with social risk factors.3The Payment Insights Team and the Value & Systems Science Lab track MIPS policy, including group practice participation, 4 as part of a portfolio monitoring and evaluating value-based payment programs.We present an analysis of safety-net practices in MIPS and discuss key policy implications.
Source: JAMA Health Forum
Authors: Joshua M. Liao, Amol S. Navathe
Language: English
Subfield: Economics and Econometrics
Domain: Social Sciences
Open Access status: hybrid
Estimated APC paid: $5,000
OpenAlex ID: W3021968245