Otolaryngologist Performance in the Merit-Based Incentive Payment System in 2017

Area of Science:

• Health Policy
• Medical Economics
• Otolaryngology

Background:

• The Merit-Based Incentive Payment System (MIPS) is a large pay-for-performance program by the Centers for Medicare & Medicaid Services (CMS).
• Understanding otolaryngologist participation and performance in MIPS since its 2017 launch is crucial for assessing its impact.
• Data on MIPS participation and outcomes for otolaryngologists were previously unclear.

Purpose of the Study:

• To characterize otolaryngologist participation and performance in the MIPS program in 2017.
• To analyze payment adjustments based on MIPS performance scores and reporting affiliations.
• To identify factors associated with MIPS success or penalties within otolaryngology.

Main Methods:

• Retrospective cross-sectional analysis of 2017 MIPS data.
• Utilized the publicly available CMS Physician Compare 2017 eligible clinician database.
• Determined participation rates, reporting affiliations (individual, group, APM), and payment adjustments based on performance scores.

Main Results:

• 68.4% of eligible otolaryngologists were required to participate in MIPS; 89.7% of those participated.
• The majority of participants (76.5%) received exceptional performance bonuses (+1.9% adjustment).
• Otolaryngologists reporting through Alternative Payment Models (APMs) had the highest rate of exceptional performance bonuses (97.1%).

Conclusions:

• Most participating otolaryngologists achieved performance bonuses in 2017, but significant variation exists.
• Otolaryngologists reporting via APMs demonstrated higher success rates in achieving bonuses.
• As MIPS evolves, otolaryngologists must adapt strategies to succeed in value-based care.