Most physicians treating Medicare patients don’t know how Medicare is evaluating and paying them, a new study concluded.
The survey of over 700 internal medicine physicians in the spring of 2017 found that more than 60% of doctors reported little to no familiarity with the Merit-based Incentive Payment System (MIPS), the new Medicare physician payment system that took effect in January 2017 and is now in its second year.
Many of the doctors also worried that the pay-for-performance incentives could harm patient care, according to the study in Health Affairs.
Researchers at the University of Washington Medicine in Seattle and the Leonard Davis Institute of Health Economics at the University of Pennsylvania conducted the web-based survey, the first since implementation of MIPS, using a national sample of doctors who are members of the American College of Physicians, the second-largest physician organization in the U.S.
“These findings indicate there is an immediate and urgent need to continue educating physicians about MIPS requirements,” said lead author Joshua M. Liao, M.D., associate medical director for contracting and value-based care at UW Medicine, in an announcement about the study.
The survey found that not all doctors have the same awareness about MIPS. Typically, those who own or run small practices are more aware of and sensitive to policy change than doctors who might work for a healthcare system, the survey found.
Not only were many physicians lacking in their knowledge about MIPS, many questioned whether MIPS will really improve quality of care, Liao said. Physicians worry Medicare’s approach could encourage doctors to “game the system,” the researchers said, as many physicians said they might change the way they practice because of the payment system.
“We found a significant number of physicians believed that there could be unintended consequences under these pay-for-performance incentives,” said Liao.
Most doctors agreed MIPS’ focus on four performance areas—reporting and performing on clinical quality measures, controlling how patients use resources, initiating or participating in clinical practice improvements and using electronic medical records—makes sense. But doctors also generally disagreed with how Medicare weighted the four areas.
Liao said of greatest concern is the belief among doctors that MIPS could have negative unintended consequences for patient care.
- 60% of respondents said they were concerned physicians might “focus on aspects of care being measured to the detriment of other unmeasured aspects of care.”
- 60% said physicians might “avoid sicker or more medically complex patients to improve performance on quality or utilization measures.”
- More than half (56%) wondered if physicians might change how they document care in order to improve their scores.