Factors Influencing Radiologist Performance in the Merit-Based Incentive Payment System

Area of Science:

• Health Policy
• Medical Economics
• Radiology

Background:

• The Merit-Based Incentive Payment System (MIPS) is a key pay-for-performance program for Medicare clinicians.
• It links clinician reimbursement to performance metrics.

Purpose of the Study:

• To evaluate radiologist performance in the 2019 MIPS program.
• To identify predictors of MIPS scores and underperformance among radiologists.

Main Methods:

• Analysis of CMS 2019 Quality Payment Program Experience Report data.
• Multivariable linear and logistic regressions to identify factors associated with MIPS scores and exceptional performance.
• Exploratory analysis of top 10 reported quality measures.

Main Results:

• 22,875 radiologists participated; 74.8% used group reporting, 4.3% individual, 20.9% MIPS Advanced Payment Model (APM).
• Mean final score was 88.8, with 88.3% achieving exceptional status.
• MIPS APM participation and larger practice size (over 500 clinicians) correlated with higher scores. Individual reporting and smaller practices were linked to lower scores and less likely exceptional performance.

Conclusions:

• The majority of radiologists performed well in 2019 MIPS, but performance varied significantly.
• Reporting method (APM, group, individual) and practice size were the strongest predictors of MIPS outcomes.
• Findings suggest potential biases within the MIPS program that warrant attention and adjustment.