Are the Best Worth the Wait? Physician Quality Scores and Access Delays

The Veterans Health Administration's (VHA) Community Care Network generally includes physicians with higher Medicare Merit-Based Incentive Payment System (MIPS) quality scores than nonparticipants, yet veterans disproportionately receive care from participating physicians with lower scores. Whether physician quality or availability influences veterans' use of community care has not been comprehensively evaluated. Our objective was to assess whether VHA community care specialists with higher MIPS quality scores receive greater referral volume or have longer wait times.

We used multivariate regression models to assess the associations between physicians' MIPS quality scores, ranging from 0 to 100, and wait times or referral volumes. We also tested whether wait time moderated the association between physician quality and referral volume.

We used administrative data to identify referrals to community-based specialists during 2021-2022. Referrals were then merged with MIPS quality scores from the Centers for Medicare & Medicaid Services using national provider identifiers.

Our sample included 83,911 specialty care referrals involving 43,736 specialists. The mean MIPS quality score was 81.9 (SD = 20.9), including 77.9% of physicians who scored ≥ 75, the threshold for a positive payment adjustment. The overall mean wait time was 21.8 days (SD = 22.0), and the mean referral volume was 6.6 per year (SD = 10.5). In covariate-adjusted regression models, MIPS scores were not associated with wait times (+0.12 days per 10-point increase, 95% CI: -0.02, 0.25) or referral volumes (-0.15 referrals per 10-point increase, 95% CI: -0.37, 0.06). Wait time did not significantly moderate the relationship between MIPS score and referral volume.

Physician quality appears to play a limited role in shaping referral decisions or access patterns in VHA community care. Although higher-scoring physicians sometimes have slightly longer wait times, these differences are small and do not translate into higher referral volumes.