The success of radiologists participating in the Medicare Merit-Based Incentive Payment System (MIPS) varies according to practice type and size, with individual radiologists being at a disadvantage, researchers have reported.
The findings suggest possible biases and imbalances in the MIPS program that should be addressed, wrote a team led by YoonKyung Chung, PhD, of the Harvey L. Neiman Health Policy Institute in Reston, VA. Chung's and colleagues' research was published February 26 in the Journal of the American College of Radiology.
"[Our study found that] most radiologists performed successfully in the 2019 MIPS, but success varied across numerous factors," the authors noted. "Reporting type and practice size were most predictive of program performance. The results reveal potential biases that should be addressed in the MIPS program."
While the aim of MIPS is to reduce costs and improve the quality of care received through rewarding high-performing clinicians across specialties and "penalizing" those who are low-performing, the program’s performance measures have been called into question through previous research. Findings from previous work have included potential biases arising from such factors as differences in patient demographics (i.e., clinicians working with more disadvantaged patient populations having poorer performance), challenges experienced with the reporting infrastructure, and self-selection by clinicians of measures that are not specialty-specific.
The authors noted that while participation in MIPS is mandatory for most Medicare radiologists, diagnostic radiologists do not usually manage patients’ care, so there are very few radiology-specific measures for MIPS.
Chung and colleagues sought to investigate radiologist performance in the 2019 MIPS program and contributing predictors for their scores. Using data primarily from the Centers for Medicare and Medicaid Services (CMS) 2019 Quality Payment Program Experience Report, the group identified factors associated with MIPS overall scores and assessed factors associated with not reaching “exceptional” performance bonus status. The investigators then analyzed the top 10 reported quality measures for 2019.
The study cohort consisted of a total of 43,554 radiologist-practice pairs with 22,875 unique radiologists. Among the radiologists, 74.8% participated in group reporting, 4.3% as an individual, and 20.9% through the MIPS Advanced Payment Model (APM). The mean final score was 88.8, with 88.3% achieving an “exceptional” score.
In their analysis, the researchers found that individual radiologists were disproportionately over-represented in the group that did not achieve “exceptional” status (20.9%) compared with their percentage in the group that did (2.1%). In fact, individual reporting increased the odds of underperformance by 7.44 times when compared with group reporting, with individual radiologists on the whole scoring 32% lower than their group reporting counterparts. Furthermore, radiologists in rural areas were also more likely to have higher odds of underperforming (odds ratio, 1.16; p < 0.05).
The study results showed that larger groups had a distinct advantage by the numbers: radiologists participating in APM entities had a 7.2-point score advantage over those reporting in groups; radiologists in practices with more than 500 members had on average a 10.3-point higher score than radiologists affiliated with practices with nine or fewer clinicians. Finally, individual reporting was associated with a 28.3-point lower score when compared with group reporting.
The team noted that its analysis had some limitations: The group weighed the MIPS scores of radiologists who had multiple MIPS scores equally, which might not have reflected the actual work. The effects of the COVID-19 pandemic were also noted as a potential question to be considered in future analysis, as the researchers had intentionally excluded pandemic data from their analysis.
"The MIPS program should provide a fair and reliable method such that all clinicians have an equal opportunity for performance-based incentives,” Chung and colleagues concluded. "[These study] results suggest systemic bias in the MIPS program and unequal opportunity to attain top scores among practicing radiologists and provides important data to inform future program design that may reduce bias and better achieve the goal of incentivizing higher value care.
Read the full study here.
