Getty Images/iStockphoto
What Drives Value in the Merit-Based Incentive Payment System?
A survey reveals physician perspectives on the value drivers within the four components of the Merit-based Incentive Payment System, showing an emphasis on process improvement activities.
In a recent survey, physicians were asked if and how the four evaluation components of the Merit-based Incentive Payment System (MIPS)—quality, promoting interoperability, improvement activities, and cost—were improving value in healthcare as intended. Performance in these areas is how MIPS determines the payment rates clinicians will receive from Medicare, with the goal of improving care through performance-based incentives.
Researchers received a 51 percent response rate out of 1,431 internal medicine physicians between March 22 and May 7, 2017. Of the respondents, 55 percent believed that value would increase through activities performed in the quality domain, 70 percent in the improvement activities domain, 54 percent through activities in promoting interoperability, and 71 percent in activities relating to cost, according to survey results published in The American Journal of Accountable Care.
The meaning of “value” in this context is up for debate. The study explains that “many payment reforms have equated value to cost reduction and stable quality. Although this is one appropriate definition, others exist.”
An alternative defines value as “improved quality with stable cost,” the study says—a definition that is recognized by Medicare and in federal statute.
The most significant driver of value in each domain was process quality, according to survey results.
“The results demonstrate that when physicians believe that MIPS domain activities positively impact value, they do so predominantly through process quality rather than other forms of quality, patient experience, or cost containment,” stated the survey.
Responses varied by gender, age, and financial incentives of the physicians, but not by specialty type or spending by region. Respondents under the age of 50 were more likely to believe that improvement activities drive value, at 74 percent, with age 50 and up at 65 percent, according to the study.
“In all four domains, more respondents believed that their efforts to improve value through reporting and performance on measures in MIPS domains were more likely to affect processes of care than outcomes,” the survey suggested.
“One potential implication is that retaining emphasis on process improvement alongside clinical outcomes and other forms of quality may be important for maintaining physician engagement in MIPS.”
As recently as 2018, physicians argued that Congress should repeal MIPS due to its quality measure choice component, which allows clinicians to choose which quality measures to be evaluated on. Many believe that this could lead to physicians only reporting on quality measures in which they perform well, incentivized by additional compensation. At the same time, it has the potential to undermine MIPS’ goal of helping patients compare physicians since they will all be reporting different quality measures, experts believe.
Since the survey responses were collected in 2017, the same year that MIPS was launched, many elements of MIPS have been altered based on feedback. In 2020, CMS enacted MIPS Value Pathways (MVPs), which will be put into practice in 2022.
“The goal is to move away from siloed reporting of measures and activities towards focused sets of measures and activities that are more meaningful to a clinician’s practice, specialty, or public health priority,” the Quality Payment Program’s website stated.
The new framework aims to streamline the reporting process, increase cohesion, and provide more meaningful feedback to participating clinicians. The MVPs include an increased focus on promoting interoperability and population health, while only focusing on reporting measures that apply to each clinician’s specialty.
Overall, clinicians will report on fewer quality measures, but ones that are more aligned to their practice. The MVPs framework addresses physician concerns about the complicated reporting process as it stands currently, while putting more focus on collecting meaningful data that will lead to better health outcomes, the website states.
