Physician Performance in the Merit-Based Incentive Payment System: Implications for Health Disparities

The Merit-Based Incentive Payment System (MIPS) was ostensibly designed to promote better care across participants. However, MIPS risks exacerbating disparities among participants with fewer resources to invest in performance metrics like care delivery improvements or quality reporting. Unfortunately, little is known about how group practice characteristics have impacted MIPS scores and associated reimbursement over time.

The analysis involved data from the MIPS Overall Clinician Performance Database, which included information about 2019 MIPS performance among all practices and clinicians. MIPS data were combined with other datasets to assess physician group practice characteristics. Additional practice- and area-level variables were obtained from the Dartmouth Atlas and the County Health Rankings file.

In the adjusted analysis, 2 practice-level characteristics (location in urban areas and larger patient populations) and 2 community-level characteristics (some college education and health care spending) were positively associated with MIPS scores. In contrast, patient population case mix and the proportion of Medicare/Medicaid dual-eligible patients were negatively associated with MIPS scores at the practice level.

The proportion of Medicare/Medicaid dual-eligible patients, but not the proportion of Black patients, was associated with lower MIPS scores. A number of other practice- and community-level characteristics were also associated with MIPS performance. These findings underscore the potential risk that MIPS may exacerbate health disparities by penalizing practices caring for lower-income populations adversely affected by social drivers of health.

To address health disparities in MIPS, policymakers could consider following precedent from other payment programs and account for practice factors when evaluating MIPS performance.