09 Sep More Merit-Based Pay for Physicians Affiliated with Health Care Systems
MedicalResearch.com Interview with:
Kenton J. Johnston, PhD
Dept of Health Management & Policy
Dept of Health & Clinical Outcomes Research
Saint Louis University
MedicalResearch.com: What is the background for this study?
Response: Consolidation of physician practices into larger health systems comprised of hospitals and other group practices has been occurring rapidly in the U.S. market over the past 10 years. During this same period, Medicare has been gradually increasing the use of “pay for performance,” or “value-based payment” programs. 2019 was the first year that nearly all physicians in the U.S. were paid under Medicare’s new mandatory Merit-Based Incentive Payment System (MIPS). We conducted a study to see whether physicians who were affiliated with health systems performed better under the MIPS than those not affiliated with health systems.
MedicalResearch.com: What are the main findings?
Response: Physicians affiliated with health systems received 26% higher merit-based performance scores, based on measures of quality of care, practice improvement activities, and meaningful use of electronic health records, than physicians not affiliated with health systems. These higher performance scores were especially driven by better performance on technology-dependent performance measures. As a result, physicians affiliated with health systems were 99% less likely to receive payment penalties and 29% more likely to receive exceptional bonus payments than physicians not affiliated with health systems. However, physicians could self-select the performance measures they were evaluated on so it is unclear whether our findings represent real differences in patient quality of care or other factors. That is an area for future research.
MedicalResearch.com: What should readers take away from your report?
Response: Physicians who affiliate with health systems appear to do substantially better under Medicare value-based payment. Because the MIPS is a zero-sum game, the financial consequences of this are that system-affiliated physicians are recipients of greater Medicare payment resources at the expense of physicians not affiliated with health systems. This is likely to amplify the existing trend toward physician consolidation within health systems as physicians seek sophisticated analytics, informatics, and administrative help to maximize performance and reimbursement under value-based payment programs.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: It is not clear whether our results mean that physicians affiliated with health systems deliver actual better quality of care to patients, engage in more advantageous self-selection of performance measures to report to Medicare, or some other factor. Research is needed to uncover the causal mechanisms that explain our results. For instance, from the patient perspective it would be important to know whether system-affiliated clinicians are delivering better quality of care on an objective set of measures that matter to patients.
MedicalResearch.com: Is there anything else you would like to add?
Response: This studied relied on publicly-reported physician and other data released by the Centers for Medicare and Medicaid Services and the Agency for Healthcare Research and Quality. I would like to advocate for the continued public release of as much data as possible on the taxpayer-funded Medicare program so that researchers can independently evaluate the performance of this program on behalf of patients and taxpayers.
Johnston KJ, Wiemken TL, Hockenberry JM, Figueroa JF, Joynt Maddox KE. Association of Clinician Health System Affiliation With Outpatient Performance Ratings in the Medicare Merit-based Incentive Payment System. JAMA. 2020;324(10):984–992. doi:10.1001/jama.2020.13136
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