Related Experiment Video
Updated: Aug 18, 2025
Inverse Probability of Treatment Weighting Propensity Score using the Military Health System Data Repository and National Death Index
Published on: January 8, 2020
Association Between Individual Primary Care Physician Merit-based Incentive Payment System Score and Measures of
Amelia M Bond1, William L Schpero1, Lawrence P Casalino1
1Division of Health Policy and Economics, Department of Population Health Sciences, Weill Cornell Medical College, New York, New York.
Importance:
The Medicare Merit-based Incentive Payment System (MIPS) influences reimbursement for hundreds of thousands of US physicians, but little is known about whether program performance accurately captures the quality of care they provide.
Objective:
To examine whether primary care physicians' MIPS scores are associated with performance on process and outcome measures.
Design, Setting, And Participants:
Cross-sectional study of 80 246 US primary care physicians participating in the MIPS program in 2019.
Exposures:
MIPS score.
Main Outcomes And Measures:
The association between physician MIPS scores and performance on 5 unadjusted process measures, 6 adjusted outcome measures, and a composite outcome measure.
Results:
The study population included 3.4 million patients attributed to 80 246 primary care physicians, including 4773 physicians with low MIPS scores (≤30), 6151 physicians with medium MIPS scores (>30-75), and 69 322 physicians with high MIPS scores (>75). Compared with physicians with high MIPS scores, physicians with low MIPS scores had significantly worse mean performance on 3 of 5 process measures: diabetic eye examinations (56.1% vs 63.2%; difference, -7.1 percentage points [95% CI, -8.0 to -6.2]; P < .001), diabetic HbA1c screening (84.6% vs 89.4%; difference, -4.8 percentage points [95% CI, -5.4 to -4.2]; P < .001), and mammography screening (58.2% vs 70.4%; difference, -12.2 percentage points [95% CI, -13.1 to -11.4]; P < .001) but significantly better mean performance on rates of influenza vaccination (78.0% vs 76.8%; difference, 1.2 percentage points [95% CI, 0.0 to 2.5]; P = .045] and tobacco screening (95.0% vs 94.1%; difference, 0.9 percentage points [95% CI, 0.3 to 1.5]; P = .001). MIPS scores were inconsistently associated with risk-adjusted patient outcomes: compared with physicians with high MIPS scores, physicians with low MIPS scores had significantly better mean performance on 1 outcome (307.6 vs 316.4 emergency department visits per 1000 patients; difference, -8.9 [95% CI, -13.7 to -4.1]; P < .001), worse performance on 1 outcome (255.4 vs 225.2 all-cause hospitalizations per 1000 patients; difference, 30.2 [95% CI, 24.8 to 35.7]; P < .001), and did not have significantly different performance on 4 ambulatory care-sensitive admission outcomes. Nineteen percent of physicians with low MIPS scores had composite outcomes performance in the top quintile, while 21% of physicians with high MIPS scores had outcomes in the bottom quintile. Physicians with low MIPS scores but superior outcomes cared for more medically complex and socially vulnerable patients, compared with physicians with low MIPS scores and poor outcomes.
Conclusions And Relevance:
Among US primary care physicians in 2019, MIPS scores were inconsistently associated with performance on process and outcome measures. These findings suggest that the MIPS program may be ineffective at measuring and incentivizing quality improvement among US physicians.
Insights
The Medicare Merit-based Incentive Payment System (MIPS) scores for primary care physicians showed inconsistent associations with patient care quality measures. This suggests MIPS may not effectively capture or incentivize true quality improvement in US physicians.
Area of Science:
- Health Services Research
- Quality Improvement
- Physician Performance Measurement
Background:
- The Medicare Merit-based Incentive Payment System (MIPS) significantly impacts physician reimbursement in the US.
- There is limited understanding of whether MIPS performance accurately reflects the quality of care provided by physicians.
Purpose of the Study:
- To investigate the association between primary care physicians' MIPS scores and their performance on key process and outcome measures.
- To evaluate the effectiveness of MIPS in measuring and incentivizing quality care.
Main Methods:
- Cross-sectional study analyzing data from 80,246 US primary care physicians participating in MIPS in 2019.
- Examined the relationship between MIPS scores (low, medium, high) and performance on 5 process measures and 7 risk-adjusted outcome measures.
- Included 3.4 million attributed patients in the analysis.
Main Results:
- Physicians with low MIPS scores demonstrated significantly worse performance on 3 of 5 process measures (e.g., diabetic eye exams, HbA1c screening, mammography screening) compared to high MIPS scorers.
- MIPS scores showed inconsistent associations with patient outcomes; low MIPS scorers had better emergency department visit rates but worse hospitalization rates.
- Physicians with low MIPS scores but superior outcomes often managed more medically complex and socially vulnerable patient populations.
Conclusions:
- MIPS scores were inconsistently associated with both process and outcome measures among US primary care physicians in 2019.
- The findings raise concerns about the MIPS program's ability to accurately measure and incentivize quality improvement.
- Further research is needed to refine performance metrics and ensure alignment with actual patient care quality.
More Related Videos
06:28Biomechanical Changes Related to Low Back Pain: An Innovative Tool for Movement Pattern Assessment and Treatment Evaluation in Rehabilitation
Published on: December 13, 2024
06:16Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease
Published on: August 9, 2024
Related Concept Videos
01:30Health Information Technology and Healthcare Information System
Health Information Technology, commonly called HIT, integrates advanced information systems and technology in healthcare settings. Its primary functions include:
01:21Methods of Documentation III: PIE
01:15Methods of Documentation VI: Case Management Model
For example, a patient with a chronic...
01:26Methods of Documentation II: POMR
01:13Patient-centered Care
01:26Methods Of Healthcare Delivery System
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is...