Abstract
The scientific validity of the Merit-Based Incentive Payment System (MIPS) quality score as a measure of hospital-level patient outcomes is unknown. To examine whether better physician performance on the MIPS quality score is associated with better hospital outcomes. This cross-sectional study of 38 830 physicians used data from the Centers for Medicare & Medicaid Services (CMS) Physician Compare (2017) merged with CMS Hospital Compare data. Data analysis was conducted from September to November 2020. Linear regression was used to examine the association between physician MIPS quality scores aggregated at the hospital level and hospitalwide measures of (1) postoperative complications, (2) failure to rescue, (3) individual postoperative complications, and (4) readmissions. The study cohort of 38 830 clinicians (5198 [14.6%] women; 12 103 [31.6%] with 11-20 years in practice) included 6580 (17.2%) general surgeons, 8978 (23.4%) orthopedic surgeons, 1617 (4.2%) vascular surgeons, 582 (1.5%) cardiac surgeons, 904 (2.4%) thoracic surgeons, 18 149 (47.4%) anesthesiologists, and 1520 (4.0%) intensivists at 3055 hospitals. The MIPS quality score was not associated with the hospital composite rate of postoperative complications. MIPS quality scores for vascular surgeons in the 11th to 25th percentile, compared with those in the 51st to 100th percentile, were associated with a 0.55-percentage point higher hospital rate of failure to rescue (95% CI, 0.06-1.04 percentage points; P = .03). MIPS quality scores for cardiac surgeons in the 1st to 10th percentile, compared with those in the 51st to 100th percentile, were associated with a 0.41-percentage point higher hospital coronary artery bypass graft (CABG) mortality rate (95% CI, 0.10-0.71 percentage points; P = .01). MIPS quality scores for cardiac surgeons in the 1st to 10th percentile and 11th to 25th percentile, compared with those in the 51st to 100th percentile, were associated with 0.65-percentage point (95% CI, 0.013-1.16 percentage points; P = .02) and 0.48-percentage point (95% CI, 0.07-0.90 percentage points; P = .02) higher hospital CABG readmission rates, respectively. In this study, better performance on the physician MIPS quality score was associated with better hospital surgical outcomes for some physician specialties during the first year of MIPS.
Highlights
Performance measurement is the centerpiece of the Center for Medicare & Medicaid Services (CMS) efforts to redesign the US health care system to deliver better patient outcomes at a lower cost
Merit-Based Incentive Payment System (MIPS) quality scores for cardiac surgeons in the 1st to 10th percentile, compared with those in the 51st to 100th percentile, were associated with a 0.41– percentage point higher hospital coronary artery bypass graft (CABG) mortality rate
MIPS quality scores for cardiac surgeons in the 1st to 10th percentile and 11th to 25th percentile, compared with those in the 51st to 100th percentile, were associated with 0.65–percentage point and 0.48–percentage point higher hospital CABG readmission rates, respectively
Summary
Performance measurement is the centerpiece of the Center for Medicare & Medicaid Services (CMS) efforts to redesign the US health care system to deliver better patient outcomes at a lower cost. Under the 2015 Medicare Access and Children’s Reauthorization Act, CMS created the Quality Payment Program, which mandates that eligible clinicians participate in either the Merit-Based Incentive Payment System (MIPS) or Advanced Alternative Payment Models. Physicians, as either individuals or groups of physicians, are evaluated in the MIPS using a composite score between 0 and 100 points based on quality, improvement activities, and promoting interoperability. They can receive a maximum of 60 points for quality (10 points for each of 6 measures).[1]. Most recommendations in clinical practice guidelines are based only on expert opinion rather than experimental evidence.[3,4] Fourth, physicians can choose to report either as individuals or as groups, and specialty physicians reporting as part of a multispecialty group may report measures that do not apply to their specialty.[2]
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