Most Surgeons Earned MIPS Bonus Payments in 2021, Study Finds

Most surgical healthcare professionals participating in the Merit-based Incentive Payment System (MIPS) earned bonus payments in 2021, with urologists seeing the highest adjustment, a study published in JAMA Surgery revealed.

MIPS aims to incentivize value over volume by adjusting physician reimbursement based on performance in four categories: quality, improvement activities, promoting interoperability, and spending. However, stakeholders have expressed concern about the program’s ability to improve care quality for patients. In addition, physicians must invest significant time and money to participate in MIPS.

Researchers used Medicare’s Quality Payment Program Experience File and Physician and Other Practitioners File to evaluate the financial impact of MIPS for surgeons in 2021. They assessed the distribution of MIPS payment adjustments by specialty and estimated changes to Part B payments.

The analysis looked at physicians in the following surgical specialties: general surgery/surgical oncology, orthopedic surgery, urology, otolaryngology, vascular surgery, plastic surgery, cardiothoracic surgery, and neurosurgery.

Almost 50,000 surgical healthcare professionals participated in MIPS during the 2021 performance year. The median composite MIPS score, which is the weighted average of the individual category scores, was 98 out of 100.

Nearly 80 percent (78 percent) of healthcare professionals received a bonus payment adjustment, while just 2 percent received penalties. The distribution of payment adjustments varied by specialty, with a lower share of orthopedic surgeons (70 percent) and otolaryngologists (71 percent) receiving bonus payments compared to other specialties.

The researchers estimated that the median increase in Part B payments based on MIPS 2021 performance was $1,341, varying among specialties. After stratifying by surgical specialty, urologists had the highest median payment increase of $2,816, while plastic surgeons had the lowest increase of $711.

Despite CMS raising MIPS thresholds in the past, most physicians continue to receive high performance scores in the program, making it difficult to recognize quality care. Additionally, the incentives surgeons receive may not offset the time and financial costs required to participate in MIPS, especially for those practicing in underserved areas and lacking necessary resources.

CMS intends for all patients to be in an accountable care relationship with downside risk by 2030. For the agency to reach this goal, it is essential that providers understand the costs, incentives, and mechanisms involved in participating in value-based payment models.

Stakeholders have considered different strategies to facilitate the shift. For example, the Making Care Primary model offers financial incentives within primary care for specialist engagement, which may allow specialists to develop quality metrics and establish financial targets for costly care.

The Value in Health Care Act of 2023 may also boost specialist participation in population-based models by increasing the amount of shared savings, minimizing entry barriers, and refining risk adjustment methods to create more equity.