MIPS Quality Score Not Often Associated with Better Patient Outcomes

Better Merit-based Incentive Payment System (MIPS) quality scores were rarely associated with lower rates of hospital complications during the first year of program implementation, according to a study published in JAMA Network Open.

Researchers studied a cohort of over 38,000 specialty physicians using CMS’s Physician Compare and Hospital Compare data from 2017, the first year of MIPS. Few physician specialties had MIPS quality scores that resulted in better surgical outcomes when compared to hospital-wide measures of individual postoperative complications, readmissions, and failure to rescue.

In a few specialties, researchers did find statistically significant associations between MIPS quality scores and surgical outcomes. But the differences were so slight that they do not provide a strong case for MIPS’s value.

MIPS quality scores for vascular surgeons in the 11th to 25th percentile were associated with a 0.55-percentage point higher rate of failure to rescue, compared to physicians in the 51st to 100th percentile of MIPS scores.

Anesthesiologists in the 1st to 10th percentile saw a 0.45-percentage point higher rate of postoperative complications compared to anesthesiologists with top-performing MIPS quality scores. In addition, cardiac surgeons with low MIPS quality scores were associated with a 0.41-percentage point higher coronary artery bypass graft (CABG) mortality rate compared to their top-performing counterparts.

Vascular surgeons and anesthesiologists were associated with slight differences in failure-to-rescue rates. Specific surgeries were also associated with small differences in mortality and readmission rates. Despite some significant connections, researchers found little evidence to support the validity of MIPS quality scores translating to overall hospital performance.

“It is perhaps not surprising that physician MIPS scores are, at best, only weakly associated with hospital performance,” the study explained.

“There are several possible explanations for this, including the unusually high number of physicians with very high MIPS scores, the preponderance of process measures as opposed to outcome measures, the lack of specialty-specific mandatory measurement sets, the absence of a fixed data submission period, and scoring adjustments by CMS unrelated to physician performance.”

MIPS, which falls under the Quality Payment Program (QPP), has faced backlash since it was introduced. Under the initial model, physicians were required to report on only six self-selected quality measures out of 271 options. Physicians could report on their best-performing measures, rather than measures that actually reflect care quality.

Physicians and industry groups called for Congress to repeal MIPS in 2018, arguing that the system does not adequately promote improved patient care. Clinicians are incentivized to pick favorable quality measures to maximize their scores and payment adjustments.

“Concerns have been raised that MIPS may not sufficiently incentivize physicians to deliver high-value care,” the study maintained. 

“However, the main problem with MIPS may not be whether the incentives are large enough to influence physician behavior but rather whether the MIPS quality score is scientifically valid and measures physicians’ contribution to outcomes.”

In an effort to appease opponents and improve the system, CMS introduced MIPS Value Pathways (MVPs) in 2020. MVPs aim to streamline the quality reporting process, focus on promoting interoperability, and improve data collection to garner meaningful insights. The model will not go into effect until 2022.

The recently proposed QPP policy changes under the Medicare Physician Fee Schedule (PFS) proposed rule introduced the first seven MVPs to align with the following clinical areas: stroke care and prevention, lower extremity joint repair, emergency medicine, anesthesia, chronic disease management, rheumatology, and heart disease.

CMS will provide a buffer period to allow physicians to get comfortable with the new rules, but the resulting administrative burdens could end up causing more harm than good.

“CMS should rethink their pay-for-performance strategy for clinicians. What has worked well for hospitals does not work for physicians. As presently constructed, MIPS does little but contribute to the 34 [percent]of US health care dollars spent on administrative activities, with only marginal gains in quality improvement,” an accompanying editorial article suggested. 

“The public would be better served by investment in high-quality clinical registries—perhaps enabled by mandatory interoperability of electronic medical records—or by a system that considers clinicians as one part of a facility-based team, with high-level clinical outcomes attributed to all participants equally. It is time to buy the emperor some new clothes—and make sure they are visible to all.”