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Physician Practice Leaders' Perceptions of Medicare's Merit-Based Incentive Payment System (MIPS)
Dhruv Khullar1,2, Amelia M Bond3, Yuting Qian3
1Division of Health Policy and Economics, Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA. khd9010@med.cornell.edu.
Background:
Medicare's Merit-based Incentive Payment System (MIPS) is a major value-based purchasing program. Little is known about how physician practice leaders view the program and its benefits and challenges.
Objective:
To understand practice leaders' perceptions of MIPS.
Design And Participants:
Interviews were conducted from December 12, 2019, to June 23, 2020, with leaders of 30 physician practices of various sizes and specialties across the USA. Practices were randomly selected using the Medical Group Management Association's membership database. Practices included small primary care and general surgery practices (1-9 physicians); medium primary care and general surgery practices (10-25 physicians); and large multispecialty practices (50 or more physicians). Participants were asked about their perceptions of MIPS measures; the program's effect on patient care; administrative burden; and rationale for participation.
Main Measures:
Major themes related to practice participation in MIPS.
Key Results:
Interviews were conducted with 30 practices representing all US census regions. Six major themes emerged: (1) MIPS is understood as a continuation of previous value-based payment programs and a precursor to future programs; (2) measures are more relevant to primary care practices than other specialties; (3) leaders are conflicted on whether the program improves patient care; (4) MIPS creates a substantial administrative burden, exacerbated by annual programmatic changes; (5) incentives are small relative to the effort needed to participate; and (6) external support for participation can be helpful. Many participants indicated that their practice only participated in MIPS to avoid financial penalties; some reported that physicians cared for fewer patients due to the program's administrative burden.
Conclusions:
Practice leaders reported several challenges related to MIPS, including irrelevant measures, administrative burden, frequent programmatic changes, and small incentives. They held mixed views on whether the program improves patient care. These findings may be useful to policymakers hoping to improve MIPS.
Insights
Physician practice leaders find Medicare
Area of Science:
- Healthcare policy
- Value-based care
- Physician practice management
Background:
- Medicare's Merit-based Incentive Payment System (MIPS) is a key value-based purchasing initiative.
- Understanding physician leaders' perspectives on MIPS is limited.
Purpose of the Study:
- To explore physician practice leaders' perceptions of the benefits and challenges of the MIPS program.
Main Methods:
- Qualitative interviews conducted with leaders from 30 diverse US physician practices.
- Practices varied in size and specialty, randomly selected from MGMA database.
- Interviews focused on MIPS measures, patient care impact, administrative burden, and participation rationale.
Main Results:
- MIPS viewed as a continuation of value-based programs; measures most relevant to primary care.
- Conflicting views on MIPS' impact on patient care; significant administrative burden noted.
- Small incentives and frequent changes pose challenges; participation often driven by penalty avoidance.
Conclusions:
- Practice leaders face challenges with MIPS measures, administrative burden, and incentives.
- Mixed perceptions exist regarding MIPS' effect on patient care quality.
- Findings offer insights for policymakers to enhance MIPS effectiveness.
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