Measuring Provider Performance for Physicians Participating in the Merit-Based Incentive Payment System

Area of Science:

• Healthcare policy
• Medical economics
• Provider performance measurement

Background:

• The Centers for Medicare and Medicaid Services mandated provider participation in the Quality Payment Program starting in 2017.
• The program offers two participation pathways: Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models.
• An estimated 83-90% of eligible providers were expected to participate in MIPS for the initial performance period.

Purpose of the Study:

• To provide plastic surgeons with an understanding of value-based care.
• To detail MIPS reporting requirements and scoring.
• To enable plastic surgeons to assess their practice performance within the Quality Payment Program.

Main Methods:

• Review of Centers for Medicare and Medicaid Services Quality Payment Program guidelines.
• Analysis of MIPS performance categories: quality, cost/resource use, improvement activities, and advancing care information.
• Discussion of MIPS scoring methodology and its impact on reimbursement.

Main Results:

• MIPS consolidates existing quality reporting programs with new performance measures.
• Provider performance is evaluated across four weighted categories.
• MIPS scores derived from 2017 data will influence 2019 reimbursement adjustments.

Conclusions:

• Understanding MIPS is crucial for plastic surgeons to navigate value-based healthcare.
• Effective participation in MIPS requires critical evaluation of practice capabilities against performance metrics.
• The Quality Payment Program signifies a shift towards performance-based reimbursement in healthcare.