Rosenkrantz Andrew B, Hirsch Joshua A, Allen Bibb, Wang Wenyi, Hughes Danny R, Nicola Gregory N
Department of Radiology, NYU Langone Medical Center, New York, New York.
Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
J Am Coll Radiol. 2017 Mar;14(3):308-315. doi: 10.1016/j.jacr.2016.10.014. Epub 2016 Dec 22.
In implementing the Merit-Based Incentive Payment System (MIPS), CMS will provide special considerations to physicians with infrequent face-to-face patient encounters by reweighting MIPS performance categories to account for the unique circumstances facing these providers. The aim of this study was to determine the impact of varying criteria on the fraction of radiologists who are likely to receive special considerations for performance assessment under MIPS.
Data from the 2014 Medicare Physician and Other Supplier file for 28,710 diagnostic radiologists were used to determine the fraction of radiologists meeting various proposed criteria for receiving special considerations. For each definition, the fraction of patient-facing encounters among all billed codes was determined for those radiologists not receiving special considerations.
When using the criterion proposed by CMS that physicians will receive special considerations if billing ≤25 evaluation and management services or surgical codes, 72.0% of diagnostic radiologists would receive special considerations, though such encounters would represent only 2.1% of billed codes among remaining diagnostic radiologists without special considerations. If CMS were to apply an alternative criterion of billing ≤100 evaluation and management codes exclusively, 98.8% of diagnostic radiologists would receive special considerations. At this threshold, patient-facing encounters would represent approximately 10% of billed codes among remaining radiologists without special considerations.
The current CMS proposed criterion for special considerations would result in a considerable fraction of radiologists being evaluated on the basis of measures that are not reflective of their practice and beyond their direct control. Alternative criteria could help ensure that radiologists are provided a fair opportunity for success in performance review under the MIPS.
在实施基于绩效的激励支付系统（MIPS）时，医疗保险和医疗补助服务中心（CMS）将对面对面患者诊疗次数较少的医生给予特殊考虑，通过对MIPS绩效类别重新加权，以考虑这些医疗服务提供者面临的独特情况。本研究的目的是确定不同标准对可能在MIPS绩效评估中获得特殊考虑的放射科医生比例的影响。
使用2014年医疗保险医生和其他供应商档案中28710名诊断放射科医生的数据，确定符合各种拟议特殊考虑标准的放射科医生比例。对于每个定义，确定未获得特殊考虑的放射科医生在所有计费代码中面对面诊疗的比例。
当使用CMS提出的标准，即如果计费≤25项评估和管理服务或手术代码，医生将获得特殊考虑时，72.0%的诊断放射科医生将获得特殊考虑，尽管在没有特殊考虑的其余诊断放射科医生中，此类诊疗仅占计费代码的2.1%。如果CMS采用仅计费≤100项评估和管理代码的替代标准，98.8%的诊断放射科医生将获得特殊考虑。在此阈值下，在没有特殊考虑的其余放射科医生中，面对面诊疗将占计费代码的约10%。
CMS目前提出的特殊考虑标准将导致相当一部分放射科医生根据不能反映其执业情况且超出其直接控制范围的指标进行评估。替代标准有助于确保放射科医生在MIPS绩效评估中获得公平的成功机会。
