MIPS may not be the way to reduce hospital readmissions by primary care doctors

While the government’s efforts to cut readmission rates by decreasing payments to hospitals seem to have worked, the same strategy may not be effective for primary care physicians.

A study found there was little variation among primary care physicians when it comes to hospital readmission rates, leaving the researchers questioning whether policies that hold these doctors accountable for reducing readmissions may miss the mark.

After programs that decreased payments to hospitals with excessive 30-day readmission rates seem to have succeeded in reducing readmissions, the Centers for Medicare & Medicaid Services (CMS) implemented a similar policy incentivizing primary care physicians to reduce hospital readmissions.

With its launch of the Merit-based Incentive Payment System (MIPS) in 2015, the pay-for-performance program included performance on readmissions as a mandatory and important measure for groups with 16 or more physicians who have more than 200 admissions per year, the study noted.

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However, an underlying assumption is that readmission rates vary by doctor independent of patient characteristics, so penalties and incentives will encourage primary care doctors to change their practice patterns to reduce readmissions compared to colleagues and increase their own payments.

The problem is those 30-day readmission rates vary only slightly among primary care physicians, according to the study published in the Annals of Internal Medicine. So, while it was easy to separate out hospitals with high readmission rates and hit them in the pocketbook, there’s no such distinction for primary care doctors.

“Our finding of minimal variation in risk for readmission among PCPs calls into question any pay-for-performance program that aims to reduce readmissions and assumes variation by PCP,” the researchers wrote. Their analysis also indicates the threshold used in MIPS of 200 or more readmissions per year is far too low to distinguish real-world differences among primary care physicians or group practices, they said.

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The researchers from the Medical College of Wisconsin and University of Texas Medical Branch studied Texas Medicare claims from 2008 to 2015 to compare 30-day readmission rates for more than 4,000 primary care physicians. They looked at data for a 47-month period, including doctors with at least 50 hospital admissions, which excluded 65% of the primary care physicians.

In contrast to previous research that showed significant variation in risk for readmission by emergency department physicians, they found almost no variation in the readmission rates by primary care physician—only 1.1 percentage points.

Those findings suggest that pay-for-performance programs to reduce readmissions on the basis of variation in readmission rates among primary care physicians may not be effective, the researchers said.

The research did find low rates of and substantial variation in early post-discharge follow-up by primary care physicians. Follow-up care for patients recently discharged from the hospital is a factor in readmission rates.