Pay-for-performance program failures raise doubts about future success of MIPS

Doctor pocketing cash
A new study adds to concerns about whether pay-for-performance programs can work to improve value.

A Medicare pay-for-performance program may have done more harm than good, a new study finds—results that don’t bode well for the future success of MIPS.

Researchers said a Medicare program designed to improve the value of care by rewarding doctors for their performance was a failure and raise doubts about whether the Merit-based Incentive Payment System (MIPS), which replaced it in January, will fare any better.

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, was a failure, and, in fact, likely exacerbated disparities in delivery, according to the study published in the Annals of Internal Medicine.

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The payment system inadvertently shifted money away from doctors who treated sicker, poorer patients to pay bonuses that rewarded practices that treated richer, healthier patients, the study said.

The researchers said those findings raise further concerns about the success of MIPS, which has the same basic design as the failed, earlier model.

“We’ve gone headlong into pay for performance despite study after study showing that it doesn’t improve quality or lower overall spending. We should expect more of the same from the MIPS because the MIPS is more of the same,” senior study author J. Michael McWilliams, M.D., professor of healthcare policy at Harvard Medical School, said in an announcement.

In October, the Medicare Payment Advisory Commission recommended the complex MIPS program be replaced with an alternative payment system. MIPS is one of two payment tracks under the Medicare Access and CHIP Reauthorization Act (MACRA) and just went into effect this year, replacing the old Sustainable Growth Rate formula, which determined Medicare payment for doctors.

MedPAC members and staff argue MIPS is too much of a burden for physicians and doesn’t accomplish the goal of rewarding high-value physicians and improving care.

But replacing MIPS isn’t so easy, as it would require statutory changes that would require congressional approval, Kate Goodrich, M.D., the Centers for Medicare & Medicaid Services’ chief medical officer, told doctors at the Medical Group Management Association conference last month.

The latest study, led by researchers from Harvard Medical School and the Department of Health Policy and Management at the University of Pittsburgh Graduate School of Public Health, concurred that the Value Modifier program, which ran from 2013 to 2016, did not appear to lower costs or improve care, and may have made things worse in terms of equity.

It shifted money away from doctors serving sicker, poorer patients because it did not properly account for differences across various patient populations in clinical and social risk factors for poor outcomes, the researchers said.

“As long as these programs do not account adequately for patient differences, which is very difficult to do, they will further deprive practices serving low-income populations of important resources," lead author Eric T. Roberts, Ph.D., assistant professor at the University of Pittsburgh, said in the announcement.

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