Plastic Surgeons and Equity: Are Merit-Based Incentive Payment System Scores Impacted by Minority Patient Caseload?

Area of Science:

• Health Services Research
• Medical Economics
• Socioeconomic Determinants of Health

Background:

• The Centers for Medicare and Medicaid Services (CMS) implemented the Merit-based Incentive Payment System (MIPS) in 2017.
• MIPS aims to transition outpatient physicians to value-based payment models.
• This study investigates factors influencing MIPS scores among plastic surgeons.

Purpose of the Study:

• To test the hypothesis that MIPS scores for plastic surgeons are affected by patient disadvantage, minority caseload, and dual eligibility.
• To analyze the relationship between patient demographics and MIPS performance scores.
• To identify potential disparities in value-based healthcare metrics.

Main Methods:

• Retrospective cohort study utilizing Medicare and MIPS data.
• Inclusion of plastic surgeons participating in MIPS.
• Analysis of patient caseload characteristics, including minority patient percentage, and MIPS scores.

Main Results:

• 1257 out of 4539 Medicare plastic surgeons participated in MIPS in the first scoring year.
• The average patient caseload comprised 85% white patients.
• Multivariable regression revealed an inverse association between higher minority patient caseload and MIPS scores.

Conclusions:

• Increasing minority patient caseload is linked to decreasing MIPS scores for plastic surgeons.
• CMS should evaluate and potentially revise MIPS measures to account for patient disadvantage.
• Ensuring equitable surgeon scoring requires addressing socioeconomic factors in value-based payment systems.