More profit to physicians for higher quality medical care seems like a good incentive. A new research study of the Merit-Based Incentive Payment System (MIPS) provides only limited support for the validity of the program.
Over time, the Centers for Medicaid and Medicare Services (CMS) have developed and tinkered with quality improvement programs to assist healthcare consumers obtain better medical service while at the same time rewarding healthcare providers who do a better job. Too often, healthcare providers look to higher patient loads, potentially unneeded tests, and other techniques as a way of boosting their income—without necessarily providing better value to their patients.
As noted in an investigation published in JAMA Network Open, the CMS has long been working to influence the US healthcare market to lower costs to consumers while at the same time providing better care (and making fewer medical mistakes). At present physicians and practice groups can be evaluated through the MIPS program or Advanced Alterative Payment Models. (APM). Like MIPS, APMs are incentive-based and are intended to provide better care to patients at a lower cost.
In MIPS, there are four categories on which physician performance is evaluated. These categories involve quality, cost, promotion of interoperability, and improvement activities. Scoring potential is different in each category. For example, quality of care ranks 40 percent of a score, cost counts for 20 percent, and improvement activities earn just 15 percent of the overall score.
The JAMA study looked at a group of 38,830 providers, including intensivists, anesthesiologists, and surgeons (general, orthopedic, and thoracic) who work at 3,055 hospitals. Ideally there would be a strong correlation with higher scores and lower postoperative complication rates. Overall? The study generally found that MIPS scores were not associated with surgical complication rates or with the “failure-to-rescue” rate. Investigators did find that cardiac surgeons with lower scores tended to be attached to hospital facilities with higher rates of readmissions and mortality from coronary bypass graft mortality.
Study authors noted, “We found limited evidence to show that better performance on the physician MIPS quality score was associated with lower rates of hospital complications in surgical patients during the first year of MIPS. Concerns have been raised that MIPS may not sufficiently incentivize physicians to deliver high-value care.”
While MIPS and other incentive models may be helpful, they do not appear to be game-changers. Given its size, wealth, and sophistication, the US healthcare industry should be able to provide lower cost, high quality health care on which consumers can rely for help without worrying about whether their choice of surgeons may leave them seriously injured—or worse.
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