Small practices lag behind big ones under MIPS
Small and rural medical practices didn’t fare nearly as well as their bigger, non-rural counterparts in the first year (2017) of the Quality Payment Program of the Centers for Medicare and Medicaid Services, researchers reported in Health Affairs.
Many large practices qualified as exceptional performers (mean and median CPS – composite performance score – of 74.37 and 90.29, respectively), while most small practices did not (mean and median CPS of 43.46 and 37.67, respectively). On average, rural practices performed worse than large practices (median CPS of 75.29 versus 90.29, respectively).
Nearly one in every five small practices (19 percent) in MIPS received negative payment adjustments compared to 5 percent of program participants overall. This could have occurred for a number of reasons, including limited ability to shoulder program reporting burden or a combined effect of inadequate risk adjustment in MIPS and high clinical or social complexity at smaller practices, according to the researchers.
Further research should examine why smaller practices appear to be at a systematic disadvantage, and policymakers should consider measures to avoid unfairly penalizing these practices in MIPS, they concluded.
Implemented through the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), QPP is a value-based payment program with two participation options: the MIPS track and the Alternative Payment Model (APM) track.
For MIPS, physicians earn a payment adjustment based on evidence that they provided high-quality, efficient care supported by technology. To do so, they must submit information in the following categories:
- Quality (50 percent of final score), which measures health care processes, outcomes, and patient care experiences.
- Promoting interoperability requirements (25 percent of final score), which promotes patient engagement and electronic exchange of information using certified electronic health record technology.
- Improvement activities (15 percent of final score), a category that gauges participation in activities that improve clinical practice, such as expanding practice access, improving care coordination and promoting patient safety.
- Cost (10 percent of final score). This category – new in 2018 – measures resources that clinicians use to care for patients, and the Medicare payments for care (items and services) given to a beneficiary during an episode of care.
Note because the “cost” category was new in 2018, it was not considered in the 2017 performance data.
Source: Health Affairs, Jan. 18, 2019