Merit-Based Incentive Payment System: longitudinal performance and uneven rewards for safety-net providers over 5...

Area of Science:

• Health economics
• Healthcare policy
• Value-based care

Background:

• Medicare Merit-based Incentive Payment System (MIPS) aims to shift reimbursement to value-based care.
• MIPS faces criticism for administrative complexity and potential inequities, particularly for safety-net providers (SNPs).

Purpose of the Study:

• To evaluate MIPS performance and financial outcomes for clinicians.
• To analyze disparities between SNPs and non-SNPs in MIPS participation and outcomes.

Main Methods:

• Analysis of 5-year MIPS data (2018-2022).
• Comparison of consistent MIPS participants, focusing on SNPs versus non-SNPs.

Main Results:

• SNPs were 31% more likely to receive positive MIPS payment adjustments.
• Despite higher adjustment rates, SNPs did not gain greater cumulative rewards due to MIPS's volume-based structure.
• MIPS financial incentives were modest ($300-$4000 over 5 years), often below administrative costs.

Conclusions:

• MIPS's structure creates inequities for safety-net clinicians.
• Policymakers should consider alternative models, like the AMA's Data-Driven Performance Payment System, to reduce administrative burden and ensure fairer rewards.