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Time and Financial Costs for Physician Practices to Participate in the Medicare Merit-based Incentive Payment System:
Dhruv Khullar1,2, Amelia M Bond1, Eloise May O'Donnell1
1Division of Health Policy and Economics, Department of Population Health Sciences, Weill Cornell Medical College, New York, New York.
Importance:
The Merit-based Incentive Payment System (MIPS) is a major Medicare value-based purchasing program, influencing payment for more than 1 million clinicians annually. There is a growing concern that MIPS increases administrative burden, and little is known about what it costs physician practices to participate in the program.
Objective:
To examine the costs for independent physician practices to participate in MIPS in 2019.
Design Setting And Participants:
This qualitative study identified and interviewed leaders of physician practices participating in the US Centers for Medicare & Medicaid Services (CMS) MIPS program, including those in MIPS alternative payment models. Time required and financial costs were calculated from responses to in-depth, semistructured interviews conducted from December 12, 2019, to June 23, 2020. Physician practices were categorized by size (small, 1-9 physicians; medium, 10-25; and large, ≥50), specialty (primary care, general surgery, or multispecialty), and US census region. Participants were asked about 2019 costs related to clinician and staff time, information technology, and external vendors. Time was converted to financial costs using the Medical Group Management Association's Provider Compensation and the Management and Staff Compensation databases.
Main Outcomes And Measures:
Annual time spent by staff on MIPS-related activities and mean per-physician costs to physician practices in 2019.
Results:
Leaders of 30 physician practices (9 [30.0%] small primary care, 6 [20.0%] small general surgery, 4 [13.3%] medium primary care, 4 [13.3%] medium general surgery, and 7 [23.3%] large multispecialty) represented all US census regions, and 14 of the 30 (46.7%) practices participated in a MIPS alternative payment model in 2019. The mean per-physician cost to practices of participating in MIPS was $12 811 (interquartile range [IQR], $2861-$17 715). Physicians, clinical staff, and administrative staff together spent 201.7 (IQR, 50.9-295.2) hours annually per physician on MIPS-related activities. Medical assistants and nursing staff together spent a mean of 99.2 (IQR, 0-163.3) hours per physician each year; frontline physicians spent 53.6 (IQR, 0.6-55.8) hours; executive administrators spent 28.6 (IQR, 3.1-26.7) hours; other clinicians and staff spent a combined 20.3 (IQR, 0-36.8) hours. Physician time accounted for the greatest proportion of overall MIPS-related costs (54%; $6909; IQR, $94-$9905).
Conclusions And Relevance:
In this qualitative study, physician practice leaders reported significant time and financial costs of participating in the MIPS program. Attention to reducing the burden of MIPS may be warranted.
Insights
Physician practices incurred significant costs to participate in the Merit-based Incentive Payment System (MIPS) in 2019, with an average of $12,811 per physician. Reducing the administrative burden of MIPS may be necessary.
Area of Science:
- Health economics
- Medical policy
- Physician practice management
Background:
- The Merit-based Incentive Payment System (MIPS) is a key Medicare value-based purchasing initiative impacting over a million clinicians.
- Concerns exist regarding MIPS increasing administrative workload and its associated costs for physician practices.
Purpose of the Study:
- To quantify the financial and time costs incurred by independent physician practices for MIPS participation in 2019.
Main Methods:
- A qualitative study involving in-depth, semistructured interviews with leaders from 30 US physician practices.
- Practices were categorized by size, specialty, and region; costs were calculated based on clinician/staff time, IT, and vendor expenses.
- Time costs were converted to financial figures using compensation databases.
Main Results:
- The mean per-physician cost for MIPS participation was $12,811 (IQR, $2861-$17,715).
- Practices spent an average of 201.7 hours per physician annually on MIPS activities.
- Physician time represented the largest cost component, accounting for 54% ($6909) of the total MIPS-related expenses.
Conclusions:
- Physician practice leaders reported substantial time and financial burdens associated with MIPS participation.
- Strategies to mitigate the administrative demands of MIPS may be warranted to support physician practices.
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