School of Medicine & Health Sciences, The George Washington University, DC, USA.
Inquiry. 2020 Jan-Dec;57:46958020971237. doi: 10.1177/0046958020971237.
Participation in the Medicare Quality Payment Program's Merit Based Incentive Payment System (MIPS) has forced many healthcare administrators to strategize how to achieve success under value-based payment systems. A financial model was constructed to determine the marginal utility of compliance with various MIPS measures. Solo, small, medium, large, and very large practices were modeled using available data and final rules published by the United States Department of Health and Human Services (HHS). The model analysis found that small groups were generally incentivized not to comply with MIPS measures. Conversely, larger organizations were found to have strong financial incentives to maximize pursuit of MIPS measures. Incentives to pursue interoperability investments were projected to be generally under $10 200 for small organizations but approximately $690 000 for very large practices whereas the health information technology (IT) resources necessary to pursue these measures may not have nearly the same range of costs. In light of these findings, small groups may be driven to join larger groups as large groups continue to capitalize on their larger incentives to pursue MIPS measures. As financial success under MIPS is dependent on scale, healthcare systems that pursue consolidation may achieve greater success under quality payment programs similar to MIPS which include the newly proposed MIPS Value Pathways (MVPs).
参与医疗保险质量支付计划的基于绩效的激励支付系统（MIPS）迫使许多医疗保健管理人员制定战略，以在基于价值的支付系统下取得成功。构建了一个财务模型来确定遵守各种 MIPS 措施的边际效用。使用可用数据和美国卫生与公众服务部（HHS）发布的最终规则对单人、小型、中型、大型和特大型实践进行建模。模型分析发现，小型团体通常被激励不遵守 MIPS 措施。相反，较大的组织被发现有强烈的财务动机来最大限度地追求 MIPS 措施。对互操作性投资的激励预计对小型组织而言通常低于 10200 美元，但对特大型实践而言约为 690000 美元，而追求这些措施所需的健康信息技术（IT）资源可能没有那么大的成本范围。鉴于这些发现，小型团体可能会被迫加入更大的团体，因为大型团体继续利用他们更大的激励来追求 MIPS 措施。由于在 MIPS 下的财务成功取决于规模，因此追求整合的医疗保健系统可能会在类似于 MIPS 的质量支付计划下取得更大的成功，其中包括新提出的 MIPS 价值途径（MVPs）。
