How Did Orthopaedic Surgeons Perform in the 2018 Centers for Medicaid & Medicare Services Merit-based Incentive Payment System?
How Did Orthopaedic Surgeons Perform in the 2018 Centers for Medicaid & Medicare Services Merit-based Incentive Payment System?
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DOI：
10.1097/corr.0000000000001981
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发表时间：
2022-01-01
影响因子：
4.2
通讯作者：
Kamath, Atul F.
中科院分区：
文献类型：
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作者：
Cwalina, Thomas B.;Jella, Tarun K.;Kamath, Atul F.
基于绩效的激励支付系统（MIPS）是由医疗保险和医疗补助服务中心实施的最新的基于价值的支付计划。随着基于绩效的奖金和处罚的幅度不断上升，评估该计划实现质量改进，成本降低和临床有意义结果竞争等核心目标的能力至关重要。问题/目的我们提出以下问题：（1）骨科医生与其他专业的外科医生相比，在MIPS评分和由此产生的奖金方面有何不同？(2)外科医生和实践的哪些特征与接受基于MIPS的处罚相关？(3)根据MIPS获得满分100分与外科医生和实践的哪些特征相关？方法使用Medicare Part B Provider Utilization and Payment File，National Plan and Provider Enumeration System Data（NPPES）和National Physician Compare Database将2018年MIPS报告期的评分与医生人口统计学和基于实践的信息联系起来。对于医师比较数据库中确定的所有骨科医生，确定了15，210个MIPS评分，代表2018年MIPS的参与率为72%（15，210/21，124）。MIPS的参与者将根据四个领域的性能指标的加权计算获得最终分数（0到100，100为满分）：质量，促进互操作性，改进活动和成本。2018年，骨科医生的总体平均+/- SD评分为87 +/- 21。根据这些分数，按以下方式确定付款调整：分数低于15分者，最高罚款调整幅度为-5%（“惩罚”），分数等于15没有收到调整（“中性”），分数在15到70之间的人得到了积极的调整得分高于70分（最高100分）的员工将获得积极的调整和额外的特殊绩效调整，最高调整幅度为+5%（“奖金”）。在不同的人口统计学和实践特征中比较了骨科医生的调整。将平均MIPS评分和由此产生的支付调整与其他亚专业的一组外科医生进行比较。最后，生成多变量逻辑回归模型，以确定哪些变量与接受惩罚的几率增加以及满分100分相关。结果与其他专业相比，骨科医生的平均MIPS评分低4.8分（95%CI 4.3 ~ 5.2; p < 0.001）。从这一差异来看，获得奖金的整形外科医生比例较低（-5.0% [95%CI-5.6至-4.3]; p < 0.001），更大比例的人受到处罚（+0.5% [95% CI 0.2至0.8]; p < 0.001）和正调整（+4.6% [95% CI 6.1至10.7]; p < 0.001）。在控制了潜在的混杂变量，如性别，实践年限和实践环境后，小（1至49名成员）团体规模（调整后的比值比22.2 [95% CI 8.17至60.3]; p < 0.001）和更高的分层疾病分类（HCC）评分（aOR 2.32 [95% CI 1.35 - 4.01]; p = 0.002）与增加的惩罚几率相关。此外，在控制了潜在的混杂因素后，我们发现通过替代支付模式进行报告（aOR 28.7 [95%CI 24.0至34.3]; p < 0.001）与满分几率增加相关，而小规模的练习（1至49名成员）（aOR 0.35 [95% CI 0.31至0.39]; p < 0.001），患者数量高（超过500名患者）（aOR 0.82 [95% CI 0.70至0.95]; p = 0.01）和较高的HCC评分（aOR 0.79 [95% CI 0.66至0.93]; p = 0.006）与MIPS评分完美的几率降低相关。结论总体而言，骨科医生在MIPS的第二年表现良好，87%的人获得奖金。在参与研究的骨科医生中，个体报告从属关系、小的实践规模和医学上更复杂的患者人群与接受处罚的几率更高和获得满分的几率更低相关。基于这些发现，我们建议，个人和骨科医生在小团体的做法，努力建立伙伴关系，与大型医院的做法，有足够的辅助人员，以支持质量报告的举措。这种伙伴关系可能有助于减轻外科医生日益增长的行政义务，并允许保持对直接病人护理活动的关注。政策制定者应该致力于制定一个缩短的绩效指标组，以确保更标准化的比较，减少从既定临床工作流程中转移的时间和精力。目前的MIPS评分方法也应该用复杂性修正因子进行修正，以确保对在安全网环境中执业的外科医生或治疗合并症负担高的患者的外科医生进行公平评价。
Background The Merit-based Incentive Payment System (MIPS) is the latest value-based payment program implemented by the Centers for Medicare & Medicaid Services. As performance-based bonuses and penalties continue to rise in magnitude, it is essential to evaluate this program's ability to achieve its core objectives of quality improvement, cost reduction, and competition around clinically meaningful outcomes. Questions/purposes We asked the following: (1) How do orthopaedic surgeons differ on the MIPS compared with surgeons in other specialties, both in terms of the MIPS scores and bonuses that derive from them? (2) What features of surgeons and practices are associated with receiving penalties based on the MIPS? (3) What features of surgeons and practices are associated with receiving a perfect score of 100 based on the MIPS? Methods Scores from the 2018 MIPS reporting period were linked to physician demographic and practice-based information using the Medicare Part B Provider Utilization and Payment File, the National Plan and Provider Enumeration System Data (NPPES), and National Physician Compare Database. For all orthopaedic surgeons identified within the Physician Compare Database, there were 15,210 MIPS scores identified, representing a 72% (15,210 of 21,124) participation rate in the 2018 MIPS. Those participating in the MIPS receive a final score (0 to 100, with 100 being a perfect score) based on a weighted calculation of performance metrics across four domains: quality, promoting interoperability, improvement activities, and costs. In 2018, orthopaedic surgeons had an overall mean +/- SD score of 87 +/- 21. From these scores, payment adjustments are determined in the following manner: scores less than 15 received a maximum penalty adjustment of -5% ("penalty"), scores equal to 15 did not receive an adjustment ("neutral"), scores between 15 and 70 received a positive adjustment ("positive"), and scores above 70 (maximum 100) received both a positive adjustment and an additional exceptional performance adjustment with a maximum adjustment of +5% ("bonus"). Adjustments among orthopaedic surgeons were compared across various demographic and practice characteristics. Both the mean MIPS score and the resulting payment adjustments were compared with a group of surgeons in other subspecialties. Finally, multivariable logistic regression models were generated to identify which variables were associated with increased odds of receiving a penalty as well as a perfect score of 100. Results Compared with surgeons in other specialties, orthopaedic surgeons' mean MIPS score was 4.8 (95% CI 4.3 to 5.2; p < 0.001) points lower. From this difference, a lower proportion of orthopaedic surgeons received bonuses (-5.0% [95% CI -5.6 to -4.3]; p < 0.001), and a greater proportion received penalties (+0.5% [95% CI 0.2 to 0.8]; p < 0.001) and positive adjustments (+4.6% [95% CI 6.1 to 10.7]; p < 0.001) compared with surgeons in other specialties. After controlling for potentially confounding variables such as gender, years in practice, and practice setting, small (1 to 49 members) group size (adjusted odds ratio 22.2 [95% CI 8.17 to 60.3]; p < 0.001) and higher Hierarchical Condition Category (HCC) scores (aOR 2.32 [95% CI 1.35 to 4.01]; p = 0.002) were associated with increased odds of a penalty. Also, after controlling for potential confounding, we found that reporting through an alternative payment model (aOR 28.7 [95% CI 24.0 to 34.3]; p < 0.001) was associated with increased odds of a perfect score, whereas small practice size (1 to 49 members) (aOR 0.35 [95% CI 0.31 to 0.39]; p < 0.001), a high patient volume (greater than 500 Medicare patients) (aOR 0.82 [95% CI 0.70 to 0.95]; p = 0.01), and higher HCC score (aOR 0.79 [95% Cl 0.66 to 0.93]; p = 0.006) were associated with decreased odds of a perfect MIPS score. Conclusion Collectively, orthopaedic surgeons performed well in the second year of the MIPS, with 87% earning bonus payments. Among participating orthopaedic surgeons, individual reporting affiliation, small practice size, and more medically complex patient populations were associated with higher odds of receiving penalties and lower odds of earning a perfect score. Based on these findings, we recommend that individuals and orthopaedic surgeons in small group practices strive to forge partnerships with larger hospital practices with adequate ancillary staff to support quality reporting initiatives. Such partnerships may help relieve surgeons of growing administrative obligations and allow for maintained focus on direct patient care activities. Policymakers should aim to produce a shortened panel of performance measures to ensure more standardized comparison and less time and energy diverted from established clinical workflows. The current MIPS scoring methodology should also be amended with a complexity modifier to ensure fair evaluation of surgeons practicing in the safety net setting, or those treating patients with a high comorbidity burden.