Complex Patient Scores Meaningfully Affect 2022 Medicare Merit-Based Incentive Payment System Bonus Payments for...

Area of Science:

• Healthcare Policy
• Orthopedic Surgery
• Health Services Research

Background:

• The Merit-Based Incentive Payment System (MIPS) significantly influences Medicare reimbursements for over 600,000 clinicians, including approximately 15,000 orthopedic surgeons.
• Evolving MIPS policies necessitate research to guide orthopedic surgeons in performance optimization and understanding payment adjustments.
• Limited research exists on the impact of recent MIPS policy changes on orthopedic surgeons' performance and care quality.

Purpose of the Study:

• To evaluate the impact of recent MIPS policy changes on payment adjustments for orthopedic surgeons.
• To examine the role of MIPS in enhancing care quality within orthopedic surgery.
• To assess disparities in MIPS bonus payments among orthopedic surgeons based on practice size and policy changes.

Main Methods:

• A retrospective analysis of 2021-2022 MIPS performance data from nearly 9000 orthopedic surgeons.
• Statistical methods included McNemar's test and mixed effects logistic regression to assess policy impacts.
• Examined changes in payment adjustments and bonus payment likelihood based on MIPS policy modifications.

Main Results:

• Increasing the MIPS performance threshold to 75 points significantly decreased the likelihood of receiving bonus payments (P < .01).
• Surgeons in smaller practices had substantially lower odds of earning bonus payments (OR, 0.40; P < .008), though this disparity has narrowed.
• The updated complex patient bonus scoring policy demonstrated the strongest positive effect on bonus payment likelihood (OR, 6.49; P < .017).

Conclusions:

• Further increases in the MIPS performance threshold may exacerbate clinician dissatisfaction.
• Despite some policy improvements, significant equity gaps persist for small and rural orthopedic practices.
• The revised complex patient bonus policy effectively incentivizes and rewards clinicians managing high-risk patient populations.