Evaluation of the Merit-Based Incentive Payment System and Surgeons Caring for Patients at High Social Risk

Area of Science:

• Health economics
• Surgical outcomes
• Value-based care

Background:

• The Centers for Medicaid & Medicare transformation aims for pay-for-value through systems like the Medicare Merit-Based Incentive Payment System (MIPS).
• Current value-based payment designs may not adequately capture social determinants of health for high-risk patients.
• The impact of MIPS on clinicians and patients with high social risk remains underexplored.

Purpose of the Study:

• To evaluate Medicare Merit-Based Incentive Payment System (MIPS) scoring for surgeons treating patients with high social risk.
• To determine if MIPS implementation could negatively affect access to surgical care for disadvantaged populations.

Main Methods:

• Retrospective cohort study of US general surgeons in the first year of MIPS.
• Data collected from outpatient surgical practices across the US and territories.
• Analysis of surgeon characteristics, MIPS scores, and practice-level disadvantage measures.

Main Results:

• Of 10,252 participating surgeons, those with higher proportions of dual-eligible patients (high social risk) received lower MIPS scores.
• Surgeons caring for the highest social risk patients had a mean MIPS score of 66.8 (SD, 37.3) compared to 71.2 (SD, 35.9) for others (P < .001).
• A wide range of dual-eligible patient caseloads (0% to 96%) was observed among surgeons.

Conclusions:

• MIPS implementation without adjustments for high social risk patient caseloads may unfairly penalize surgeons.
• This could potentially impact the care and access for vulnerable patient populations.
• Further research is needed to refine value-based care models to ensure equity.