Oncologist Participation and Performance in the Merit-Based Incentive Payment System

Area of Science:

• Health Services Research
• Oncology
• Health Policy

Background:

• The Merit-based Incentive Payment System (MIPS) is a value-based payment model by the Centers for Medicare & Medicaid Services (CMS).
• MIPS aims to enhance healthcare value through performance-based adjustments to Medicare reimbursements.
• Understanding oncologist participation and performance in MIPS is crucial for optimizing value-based care initiatives.

Purpose of the Study:

• To examine the participation rates of oncologists in the 2019 MIPS.
• To analyze the factors influencing MIPS performance among oncologists.
• To identify areas for improvement in MIPS engagement and scoring for oncology practices.

Main Methods:

• A cross-sectional study design was employed.
• Data on oncologist participation and performance in the 2019 MIPS were analyzed.
• Statistical adjustments were made for practice characteristics and patient complexity.

Main Results:

• Oncologist participation in MIPS was 86%, lower than the 97% all-specialty participation rate.
• Oncologists utilizing alternative payment models (APMs) achieved higher MIPS scores (mean 91) compared to individual filers (mean 77.6).
• Increased patient complexity was associated with slightly lower MIPS scores, suggesting a need for improved risk adjustment.

Conclusions:

• Oncologist engagement in MIPS requires attention, particularly regarding participation rates.
• Alternative payment models may facilitate better MIPS performance, highlighting the role of organizational resources.
• CMS should consider refining risk-adjustment methodologies to better account for patient complexity in MIPS.