Nate C. Apathy is a postdoctoral fellow at the Perelman School of Medicine and Leonard Davis Institute of Health Economics, both at the University of Pennsylvania, in Philadelphia, Pennsylvania. At the time the study was conducted, he was a doctoral student in the Department of Health Policy and Management at Indiana University, in Indianapolis, Indiana.
Jordan Everson (
Health Aff (Millwood). 2020 Sep;39(9):1513-1521. doi: 10.1377/hlthaff.2019.01648.
There has been widespread concern over the design of the Merit-based Incentive Payment System (MIPS) since its authorization with the Medicare Access and CHIP Reauthorization Act of 2015. Using detailed performance data from 2017, the first implementation year of MIPS, we found that although 90 percent of participating clinicians reported performance equal to or better than the low performance threshold of 3 out of 100 (a calculated composite score), almost half of clinicians did not participate in at least one of the three program categories (quality, advancing care information, and improvement activities). The decision to participate in each category explained 86 percent of the total variance in clinicians' overall score, whereas actual performance explained just 14 percent, as a result of the ease of achieving high scores within each category. Still, 74 percent of clinicians who only partially participated in the program received positive payment adjustments. These findings underline concerns that MIPS's design may have been too flexible to effectively incentivize clinicians to make incremental progress across all targeted aspects of the program. In turn, this is likely to lead to resistance when payment penalties become more severe in 2022, as required by the MIPS authorizing legislation.
自 2015 年《平价医疗法案》和《儿童健康保险计划再授权法案》授权实施基于价值的激励支付系统（Merit-based Incentive Payment System，MIPS）以来，人们对其设计一直存在广泛关注。我们利用 2017 年（即 MIPS 的首个实施年）的详细绩效数据发现，尽管 90%的参与医生报告的绩效等于或高于 3/100 的低绩效阈值（经计算得出的综合评分），但几乎一半的医生没有参与至少三个方案类别中的一个（质量、推进医疗信息和改进活动）。参与每个类别的决定解释了医生总体得分总方差的 86%，而实际绩效仅解释了 14%，原因是在每个类别中很容易获得高分。尽管如此，仅部分参与该计划的医生中仍有 74%获得了正向支付调整。这些发现强调了人们的担忧，即 MIPS 的设计可能过于灵活，无法有效激励医生在计划的所有目标方面取得渐进式进展。反过来，这可能会导致在 2022 年 MIPS 授权立法要求支付处罚更加严厉时，引发抵触情绪。
