Study finds almost 30% of practices take Medicare penalty rather than participate in P4P program

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Almost one-third of practices took a penalty rather than participate in a Medicare pay-for-performance program. (Photo by jansucko/iStock/Getty Images Plus/Getty Images)

If history is any indicator, there will be lots of doctors and physician practices that don’t participate in MIPS and instead take the financial penalty that cuts their Medicare revenue.

A new study found that 29.3% of eligible practices failed to report quality data during the first year of a Medicare pay-for-performance program that was the predecessor of the complex Merit-based Incentive Payment System (MIPS), which took effect in January.

Organizations that represent physicians have been urging doctors to take the minimum steps to participate in MIPS and avoid a negative 4% Medicare payment adjustment in 2019.

And while the clock is rapidly winding down since doctors must act before the end of the year, if the study, published in Health Affairs, provides any indicators, many doctors will choose the financial hit to avoid the burden of reporting quality data to the government.

Researchers looked at participation during the first year of Medicare’s Value-Based Payment Modifier Program, which was designed to improve value by paying doctors who perform better on measures of quality and spending. In that first year, the program included practices with 100 or more clinicians. The study found that 899 practices with Medicare patients met the criteria, but 263 failed to report performance data and received a 1% penalty as a result.

“The burden is significant,” one of the study’s authors, Karen Joynt Maddox, M.D., an assistant professor of medicine at Washington University School of Medicine in St. Louis, told the Healthcare Financial Management Association. She explained why almost one-third of practices would voluntarily lose revenue: “We are a long way from the kinds of electronic, record-keeping infrastructure that we need.”

In fact, the study found that of the 636 practices that reported performance data, those with high use of electronic health records had better performance on quality and costs than other practices. The researchers echoed similar calls for greater technical assistance and support, particularly for smaller practices.

It is the second recent study to raise concerns about the future success of MIPs, one of two payment tracks under the Medicare Access and CHIP Reauthorization Act (MACRA). A study published late last month found that the Value Modifier program was a failure and may have exacerbated disparities in care delivery.

RELATED: Doctors face barriers in move to value-based care under MACRA, congressional committee told

In October, the Medicare Payment Advisory Commission recommended that the complex MIPS program be replaced with an alternative payment system.

In its first year of implementation, doctors can avoid a penalty under MIPS by reporting one quality measure on one patient. That will get tougher in 2018, as practices will need to report a full year of quality data under a final rule released in November, although the government will decrease the number of clinicians required to participate in the program.