Call for Specialty-Specific Benchmarks for Cross-Specialty Quality Measures in the Quality Payment Program.

Abstract

The introduction of the Quality Payment Program (QPP) by the Centers for Medicare & Medicaid Services (CMS) played a critical role in the process of transitioning U.S. healthcare from a pay-for-service to a pay-for-performance system. Physicians can participate in the QPP through one of three reporting methods: the traditional merit-based incentive payment system (MIPS), MIPS Value Pathways (MVPs), or Advanced Alternative Payment Models (APMs). These reporting methods require physicians to submit data on quality measures, which are averaged to determine a total quality performance score, which is weighted along with other QPP measures related to self-performance to provide an aggregate final performance score. This final score is used to determine either a negative, neutral, or positive percentage modifier for the physician's Medicare reimbursement payments, which applies to the fiscal year two years following the year of reporting. Quality measures are either specialty-specific or cross-specialty, meaning that they are reportable by any physician specialty. No studies have compared performance across physician specialty categories on these measures. Critics argue that CMS has not ensured equitable reporting of cross-specialty quality measures due to the difference in emphasis on aspects of care of different physician specialties, potentially advantaging some. For example, family medicine physicians may score higher on the blood pressure control quality measure due to its relevance in their practice. Significant performance differences could highlight areas of improvement for certain physicians in certain specialties and guide balanced measure development. The QPP currently uses non-specialty-specific historical quality performance scores as benchmarks to determine current-year quality measure scores, likely leading to unfair comparisons. Establishing specialty-specific benchmarks for cross-specialty measures would promote equitable evaluation and fair competition among all participating physicians.