Intended and Unintended Consequences of the Merit-Based Incentive Payments System Program: Early Evidence

绩效激励支付系统计划的预期和非预期后果：早期证据

• 批准号: 10373483
• 负责人: Meng-Yun Lin
• 金额: $ 22.8万
• 依托单位: WAKE FOREST UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10373483
• 关键词: Affect; Behavior; Caring; Characteristics; Child Health; Clinical; Complex; Data; Data Reporting; District of Columbia; Electronic Health Record; Evaluation; Evolution; Fee-for-Service Plans; Future; Health Insurance; Hospitals; Incentives; Knowledge; Link; Medical; Medicare; Medicare Part B; Medicare claim; Modeling; Oncology; Outcome; Patient Care; Patient risk; Patient-Focused Outcomes; Patients; Performance; Physicians; Policies; Program Evaluation; Provider; Quality of Care; Reporting; Research; Risk; Risk Adjustment; Sampling; Social Characteristics; System; United States Centers for Medicare and Medicaid Services; adverse outcome; base; beneficiary; care costs; care outcomes; cohort; cost; ethnic minority; experience; health disparity; high reward; high risk; high risk population; improved; incentive program; inpatient service; medical specialties; payment; profiles in patients; programs; racial and ethnic; response; social disadvantage; urban area; Affect; Behavior; Caring; Characteristics; Child Health; Clinical; Complex; Data; Data Reporting; District of Columbia; Electronic Health Record; Evaluation; Evolution; Fee-for-Service Plans; Future; Health Insurance; Hospitals; Incentives; Knowledge; Link; Medical; Medicare; Medicare Part B; Medicare claim; Modeling; Oncology; Outcome; Patient Care; Patient risk; Patient-Focused Outcomes; Patients; Performance; Physicians; Policies; Program Evaluation; Provider; Quality of Care; Reporting; Research; Risk; Risk Adjustment; Sampling; Social Characteristics; System; United States Centers for Medicare and Medicaid Services; adverse outcome; base; beneficiary; care costs; care outcomes; cohort; cost; ethnic minority; experience; health disparity; high reward; high risk; high risk population; improved; incentive program; inpatient service; medical specialties; payment; profiles in patients; programs; racial and ethnic; response; social disadvantage; urban area

Under the Medicare Access and Children's Health Insurance Program Reauthorization Act (2015), the Center for Medicare & Medicaid Services (CMS) established the Merit-Based Incentive Payment System Program (MIPS). The program ended the long-standing system that reimbursed clinicians on a fee-for-service basis and shifted Medicare to a system that rewards higher-quality and lower-cost care. Under MIPS, clinicians are required to report data on performance in four domains: quality of care, participation in improvement activities, meaningful use of electronic health records, and cost. CMS weighs each domain to calculate a Composite Performance Score. The program became effective in 2017, with performance scores publicly reported. Starting in 2019, clinicians began receiving payment adjustments of up to 4% of their Medicare Part B payments based on the performance scores achieved in 2017. The adjustment can be upward or downward, and the maximum adjustment is set to increase to 5% in 2020 and 9% from 2022 onward. Four years since MIPS took effect, there is little evidence for its impact on the intended targets (quality and cost of care). Furthermore, similar to many earlier value-based programs that CMS introduced, MIPS has raised concerns about incentivizing strategic responses with little impact on quality of care. For example, to avoid payment reductions, MIPS clinicians may strategically lower their patient risk profiles by referring out high-risk patients, potentially leading to disparities in health outcomes. No research to date has examined the potential unintended effect of MIPS. To fill these knowledge gaps, we propose to examine both desired and potential unintended adverse consequences of MIPS using data from the first three years of the program (2017-2019). This study will use a nationally-representative random sample of MIPS-participating clinicians and their patients from 50 states and the District of Columbia. We will merge several provider-level CMS public reporting data with patient-level Medicare claims data to link participating providers with their attributed patients. Our specific aims are to (1) examine if there are systematic differences in the characteristics of providers and patient profiles by performance scores and (2) evaluate the extent to which performance improvements are associated with changes in healthcare outcomes and patient profiles. This will be the first study to examine the intended (improved healthcare outcome) and unintended effects (changes in patient risk profile) of MIPS. Findings from the first three years of MIPS will inform CMS on the evolution and refinement of the program and serve as the basis for future research on MIPS performance at a larger scale and over later years.

根据Medicare Access和儿童健康保险计划重新授权法（2015年），该中心 Medicare＆Medicaid服务（CMS）建立了基于绩效的激励支付系统计划 （MIPS）。该计划终止了长期的系统，该系统以支付费用的基础向临床医生报销 将Medicare转移到了奖励更高质量和低成本护理的系统。在MIP下，临床医生是 需要报告四个领域绩效的数据：护理质量，参与改进活动， 有意义地使用电子健康记录和成本。 CMS称重每个域以计算复合材料 性能得分。该计划在2017年生效，其性能得分公开报道。 从2019年开始，临床医生开始接受多达4％Medicare B部分的付款调整 根据2017年达到的性能得分的付款。调整可以向上或向下， 并且最大调整设置为2020年，从2022年开始增加到9％。 自MIP生效四年以来，几乎没有证据表明其对预期目标的影响（质量和 护理费用）。此外，类似于CMS引入的许多早期基于价值的程序，MIPS具有 引起了人们对激励战略反应的担忧，对护理质量的影响很小。例如 避免减少付款，MIPS临床医生可以通过参考来战略性地降低患者的风险状况 高危患者，可能导致健康结果差异。迄今为止还没有研究 MIP的潜在意外影响。 为了填补这些知识空白，我们建议检查所需的和潜在的意外不利 使用该计划的前三年（2017-2019）中使用数据的MIP的后果。这项研究将使用 来自50个州的参与MIPS的临床医生及其患者的全国代表性随机样本 哥伦比亚特区。我们将合并几个提供商级别的CMS公共报告数据与患者级 Medicare声称数据将参与提供者与其归因于患者联系起来。我们的具体目的是（1） 检查提供者的特征和患者概况是否存在系统差异 性能得分和（2）评估绩效改善与之相关的程度 医疗保健结果和患者概况的变化。 这将是第一个研究预期的（改善医疗保健结果）和意外影响的研究 （患者风险概况的变化）MIPS。 MIP的前三年的发现将通知CMS 该计划的进化和完善，并作为对MIPS表现的未来研究的基础 更大的规模和后来的几年。