Incorporating Cost Measures Into the Merit-Based Incentive Payment System: Implications for Oncologists

Area of Science:

• Health Policy
• Health Economics
• Oncology

Background:

• The Merit-Based Incentive Payment System (MIPS) is the primary federal value-based payment model for physicians in the United States.
• MIPS has progressively increased the weight of cost measures, rising from 0% in 2017 to 30% in 2022.
• Specialty-agnostic cost measures may disproportionately impact high-cost specialties like oncology.

Purpose of the Study:

• To investigate the impact of MIPS cost measure integration on physician reimbursement.
• To analyze the financial implications for oncologists compared to other medical specialties.

Main Methods:

• Evaluation of physician performance data from the 2018 MIPS using the Doctors and Clinicians database.
• Application of multivariable Tobit regression to identify factors associated with cost and quality scores.
• Simulation of 2022 MIPS composite scores and payment adjustments using 2018 data to compare cross-specialty changes.

Main Results:

• Oncologists represented 3.5% of MIPS-participating physicians and exhibited lower cost scores (58.4) than non-oncologists (71.0).
• After applying 2022 cost-quality weights, oncologists experienced a 4.3-point reduction in composite MIPS scores.
• Oncologists faced a four-fold increase in penalty magnitude (from $4,233.41 to $18,531.06) and a greater reduction in exceptional payment bonuses compared to other specialties.

Conclusions:

• Oncologists are likely to be disproportionately penalized by the current MIPS cost measure structure.
• Specialty-specific recalibration of MIPS cost measures is essential.
• Policy adjustments are needed to prevent value-based care initiatives from negatively impacting healthcare quality and patient outcomes.