Otolaryngologist Performance in the Merit-Based Incentive Payment System in 2018

Area of Science:

• Health Services Research
• Medical Economics
• Otolaryngology

Background:

• The Centers for Medicare and Medicaid Services implemented the Merit-Based Incentive Payment System (MIPS) in 2017, a significant pay-for-performance initiative.
• MIPS participation requirements and performance thresholds increased in its first full program year, 2018.

Purpose of the Study:

• To analyze otolaryngologist participation and performance in the MIPS program during 2017 and 2018.
• To identify factors influencing MIPS performance and payment adjustments within otolaryngology.

Main Methods:

• Retrospective cross-sectional analysis of publicly available Medicare data for 2017 and 2018.
• Comparison of MIPS participation and payment adjustment outcomes based on reporting status (individual, group, alternative payment models).

Main Results:

• In 2018, otolaryngologists reporting as individuals had lower rates of positive payment adjustments (67.9%) compared to group (99.9%) or alternative payment model (100.0%) participants.
• Nearly 30% of otolaryngologists changed their reporting affiliations between 2017 and 2018.
• Those transitioning from individual to alternative payment model participation showed the most substantial performance score improvements (median change +23.4 points).

Conclusions:

• Otolaryngologists participating in groups or alternative payment models generally achieve better MIPS outcomes.
• Practice affiliation changes, particularly towards alternative payment models, are associated with significant performance gains.
• Findings highlight challenges and opportunities for independent otolaryngology practices navigating value-based care under MIPS.