Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Department of Emergency Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
J Gen Intern Med. 2019 Oct;34(10):2275-2281. doi: 10.1007/s11606-019-05207-z. Epub 2019 Jul 31.
While both administrators of pay-for-performance programs and practicing physicians strive to improve healthcare quality, they sometimes disagree on the best approach. The Medicare Access and CHIP Reauthorization Act of 2015 mandated the creation of the Merit-Based Incentive Payment System (MIPS), a program that incentivizes more than 700,000 physician participants to report on four domains of care, including healthcare quality. While MIPS performance scores were recently released, little is known about how primary care physicians (PCPs) and their practices are being affected by the program and what actions they are taking in response to MIPS.
To (1) describe PCP perspectives and self-reported practice changes related to quality measurement under MIPS and (2) disseminate PCP suggestions for improving the program.
Qualitative study employing semi-structured interviews.
Twenty PCPs trained in internal medicine or family medicine who were expected to report under MIPS for calendar year 2017 were interviewed between October 2017 and June 2018. Eight PCPs self-reported to be knowledgeable about MIPS. Seven PCPs worked in small practices.
Most PCPs identified advantages of quality measurement under MIPS, including the creation of practice-level systems for quality improvement. However, they also cited disadvantages, including administrative burdens and fears that practices serving vulnerable patients could be penalized. Many participants reported using technology or altering staffing to help with data collection and performance improvement. A few participants were considering selling small practices or joining larger ones to avoid administrative tasks. Suggestions for improving MIPS included simplifying the program to reduce administrative burdens, protecting practices serving vulnerable populations, and improving communication between program administrators and PCPs.
MIPS is succeeding in nudging PCPs to develop quality measurement and improvement systems, but PCPs are concerned that administrative burdens are leading to the diversion of clinical resources away from patient-centered care and negatively impacting patient and clinician satisfaction. Program administrators should improve communication with participants and consider simplifying the program to make it less burdensome. Future work should be done to investigate how technical assistance programs can target PCPs that serve vulnerable patient populations and are having difficulty adapting to MIPS.
尽管支付绩效计划的管理者和执业医师都致力于改善医疗质量，但他们有时在最佳方法上存在分歧。2015 年《平价医疗法案》和《儿童健康保险计划再授权法案》要求创建基于绩效的激励支付系统（MIPS），该系统激励 70 多万名医生报告四个护理领域的情况，包括医疗质量。尽管 MIPS 的绩效评分最近已经公布，但人们对初级保健医生（PCP）及其实践受到该计划的影响以及他们针对 MIPS 采取的措施知之甚少。
（1）描述 PCP 对 MIPS 下质量测量的看法和自我报告的实践变化，以及（2）传播 PCP 对改善该计划的建议。
采用半结构化访谈的定性研究。
2017 年日历年内预计根据 MIPS 报告的接受过内科或家庭医学培训的 20 名 PCP 接受了访谈，访谈时间为 2017 年 10 月至 2018 年 6 月。8 名 PCP 自我报告称对 MIPS 有所了解。7 名 PCP 在小诊所工作。
大多数 PCP 确定了 MIPS 下质量测量的优势，包括为质量改进创建实践层面的系统。然而，他们也指出了一些缺点，包括行政负担和担心为弱势群体服务的实践可能受到惩罚。许多参与者报告说，他们正在使用技术或改变人员配备来帮助数据收集和绩效改进。一些参与者正在考虑出售小诊所或加入更大的诊所，以避免行政任务。改善 MIPS 的建议包括简化程序以减轻行政负担，保护为弱势群体服务的实践，以及改善计划管理者与 PCP 之间的沟通。
MIPS 成功地促使 PCP 发展质量测量和改进系统，但 PCP 担心行政负担导致临床资源从以患者为中心的护理转移，并对患者和临床医生的满意度产生负面影响。计划管理者应改善与参与者的沟通，并考虑简化程序以减轻其负担。应进一步开展工作，调查技术援助计划如何针对为弱势患者群体服务且难以适应 MIPS 的 PCP。
