There is “limited evidence” suggesting that physicians’ Merit-based Incentive Payment System (MIPS) scores are tied to better outcomes among surgical patients, according to a newly published study.
While researchers found a spattering of “small but clinically meaningful” associations between the physician scores and surgical complications—particularly among cardiac surgeons—their broader analysis suggests a feeble relationship between the Center for Medicare & Medicaid Services’ (CMS') physician performance measures and hospital outcomes.
“Concerns have been raised that MIPS may not sufficiently incentivize physicians to deliver high-value care,” University of Rochester School of Medicine researchers wrote in JAMA Network Open. “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.”
The team’s study reviewed a cohort of 38,830 clinicians from 3,055 hospitals that included anesthesiologists (47.4%), orthopedic surgeons (23.4%) general surgeons (17.2%) and other surgical specialists.
Using data from publicly available CMS Physician Compare, CMS Hospital Compare and other CMS data sets for 2017, they sought associations between hospital-level clinician MIPS scores and the hospital’s measures of postoperative complications, deaths among inpatients with treatable complications (failure to rescue) and other specialty-specific outcomes.
The researchers’ analysis found no association between the weighted mean of a hospital’s physician MIPS quality scores and the facility’s rate of postoperative complications. Higher failure-to-rescue rates were seen among vascular surgeons and anesthesiologists with lower MIPS scores.
For outcomes and complications tied to specific specialties, the analysis showed a significant relationship between low-scoring cardiac surgeons and higher coronary artery bypass graft (CABG) mortality and readmission.
However, the study found no associations between other specialties’ MIPS scores and their CABG or hip and knee outcomes.
The researchers wrote that the weak associations between MIPS scores and hospital performance were not that surprising and pointed to a handful of potential explanations for the disconnect.
These included “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,” they wrote.
In an accompanying editorial published by the journal, Richard Dutton, M.D., an anesthesiologist affiliated with Texas A&M University College of Medicine, described the analysis as “a damning assessment” of CMS’ quality measure.
Failure to report the data to CMS in 2021 will result in a 9% penalty to 2023 reimbursement, driving the majority of physicians to continue participating in the program despite widespread skepticism among private practice clinicians who “regard MIPS as a regulatory tax to be met with the least possible investment of either money or time,” Dutton wrote.
The agency and industry have spent billions to develop and meet quality measures “that might be reassuring to the public because performance is uniformly high but do nothing to demonstrate variations in care that might enable quality improvement,” he wrote. Those efforts could be better spent elsewhere in the healthcare system, he said.
“What has worked well for hospitals does not work for physicians,” Dutton wrote. “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.”