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

基本信息

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
项目类别：
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

项目摘要

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《医疗保险和儿童健康保险计划重新授权法案》（2015 年），该中心医疗保险和医疗补助服务 (CMS) 制定了基于绩效的激励支付系统计划（MIPS）。该计划结束了长期存在的按服务收费向临床医生报销的制度，将医疗保险转变为奖励更高质量和更低成本护理的系统。根据 MIPS，临床医生需要报告四个领域的绩效数据：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 权衡每个域以计算综合表现得分。该计划于 2017 年生效，并公开报告绩效分数。从 2019 年开始，临床医生开始接受高达 Medicare B 部分 4% 的付款调整根据2017年取得的绩效分数支付。调整可以向上或向下， 2020年最高调整幅度为5%，2022年起调整幅度为9%。自 MIPS 生效四年以来，几乎没有证据表明它对预期目标（质量和护理费用）。此外，与 CMS 推出的许多早期基于价值的计划类似，MIPS 也提出了对激励战略反应对护理质量几乎没有影响的担忧。例如，要为了避免付款减少，MIPS 临床医生可以通过推荐来战略性地降低患者风险状况高风险患者，可能导致健康结果的差异。迄今为止还没有研究检验过 MIPS 的潜在意外影响。为了填补这些知识空白，我们建议检查期望的和潜在的意外不利 MIPS 使用该计划前三年（2017-2019 年）数据的后果。本研究将使用一个来自 50 个州和地区的参与 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。我们将把多个提供商级别的 CMS 公共报告数据与患者级别合并医疗保险索赔数据将参与的提供者与其归属的患者联系起来。我们的具体目标是 (1) 检查提供者的特征和患者概况是否存在系统性差异绩效分数；(2) 评估绩效改进与以下因素相关的程度：医疗保健结果和患者概况的变化。这将是第一项检查预期（改善医疗保健结果）和非预期影响的研究 MIPS（患者风险状况的变化）。 MIPS 前三年的调查结果将告知 CMS 该程序的演变和完善，并作为未来 MIPS 性能研究的基础规模更大，并在以后的几年里。