Doctors affiliated with health systems have much higher MIPS scores, JAMA study finds

Dive Brief:

  • Clinicians who were affiliated with a health system had "significantly better" performance scores under the Merit-based Incentive Payment System than those who were unaffiliated, according to a JAMA study published Tuesday. The researchers noted, however, that the study does not determine whether affiliated physicians were providing better quality care, raising questions about the program's efficacy that need further research.
  • The differences were especially stark for technology-dependent measures like giving patients access to health records and electronic prescribing, which could be due to the technology and infrastructure a system can provide, the authors said.
  • A separate study, also published Tuesday in JAMA, found that physicians who had the highest proportion of patients dually eligible for Medicare and Medicaid had significantly lowers MIPS scores than other doctors.

Dive Insight:

MIPS, which began collecting performance data in 2017, is intended to help move the U.S. healthcare system further toward one that pays for value and quality instead of purely fee-for-service. 

The direct result of the findings — that clinicians with health systems have higher performance scores that are statistically significant — is that those practitioners are more highly compensated.

In a concurrently published op-ed, health experts note that value-based programs like MIPS could be disproportionately rewarding well-off health systems and penalizing smaller practices and clinicians serving disadvantaged populations.

"The key question arising from these studies is whether MIPS measures represent clinical quality, or simply reflect resources to support strategic measure selection and reporting," they wrote.

Those authors suggest remedies such as adjusting performance payments for patient social and contextual factors, giving upfront payments to doctors who serve disadvantaged populations and changing the way performance outcomes are chosen for reporting. Ultimately, they conclude that programs like MIPS "need to be fundamentally reshaped."

They aren't the only critics of the program. The Medicare Payment Advisory Commission has frequently chided the initiative and called for its complete repeal in favor of a consolidated, value-based program. MedPAC members argued the system tracks metrics like whether a test is ordered better than actual quality of patient care.

Hospital acquisition of private medical practices has increased dramatically in recent years. The percentage of physicians in practices owned by hospitals jumped from 25% in 2010 to 40% in 2016, according to a 2018 Health Affairs study. Also that year, Avalere found a 63% increase in physicians employed by hospitals between 2012 and 2016.

For the affiliation study, researchers examined more than 600,000 clinicians with MIPS data for 2019, which is based on performance metrics from 2017. Those who were affiliated with a health system had a mean MIPS performance score of 79 (on a scale of 0 to 100) compared to a score of 60 for those unaffiliated.

Each health system had at least one hospital and one multispecialty physician group practice. Nearly half of the clinicians studied were associated with a system.

The other study looked at a sample of more than 280,000 physicians and divided them into five categories based on the proportion of dual eligible patient population. The average MIPS score for those in the tier with the most dual eligibles was 64.7, compared to 75.9 in the tier with the least.