Current Interventional Radiology-Related Benchmarked Clinical Quality Measures Are Less Likely to be "Capped" Than...

Area of Science:

• Radiology
• Health Economics
• Healthcare Policy

Background:

• The Merit-based Incentive Payment System (MIPS) uses quality measures to adjust payments.
• Quality measures with high performance rates (≥95%) are deemed 'topped out' and may have their point values capped.
• This capping affects the potential payment adjustments for clinicians.

Purpose of the Study:

• To compare the availability of 10-point quality measures between diagnostic radiology (DR) and interventional radiology (IR) within the MIPS program.
• To assess the implications for mixed DR/IR groups seeking to optimize their MIPS payment adjustments.

Main Methods:

• A review of 196 clinical quality measures within the MIPS program was conducted.
• Measures were categorized as either DR-related or IR-related.
• The number of 10-point measures available in each category was compared.

Main Results:

• A significantly higher proportion of IR-related measures were worth 10 points compared to DR-related measures (9 out of 12 IR measures vs. 2 out of 9 DR measures).
• The difference in the availability of 10-point measures between IR and DR was statistically significant (P = .03).

Conclusions:

• Interventional radiology services offer a greater number of high-value MIPS quality measures.
• Mixed diagnostic and interventional radiology groups can potentially maximize their Medicare payment adjustments by focusing on clinical IR services.