基于绩效的眼科医生激励支付制度的经济学评价：2019 年质量支付计划数据的分析。

Economic Evaluation of the Merit-Based Incentive Payment System for Ophthalmologists: Analysis of 2019 Quality Payment Program Data.

机构信息

Department of Ophthalmology, Vanderbilt University Medical Center, Nashville, Tennessee.

Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor.

出版信息

JAMA Ophthalmol. 2022 May 1;140(5):512-518. doi: 10.1001/jamaophthalmol.2022.0798.

DOI:10.1001/jamaophthalmol.2022.0798

PMID:35420641

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9011174/

Abstract

IMPORTANCE

The Merit-Based Incentive Payment System (MIPS) is intended to promote high-value health care through quality-related Medicare payment adjustments.

OBJECTIVE

To assess the economic evaluation of MIPS scoring and reporting on ophthalmologists.

DESIGN, SETTING, AND PARTICIPANTS: In this retrospective, cross-sectional, multicenter economic evaluation conducted from October 10 to November 30, 2021, MIPS performance and related payment adjustments were evaluated using the US Centers for Medicare & Medicaid Service (CMS) public data files for ophthalmologists. Participants were stratified by reporting affiliation. Analysis of variance and summary statistics were used to characterize and compare total and subcategory MIPS scores and adjustments received by participants. Reported CMS methodology and performance year (PY) 2019 payment percentages were used to estimate payment adjustments for the following categories: positive MIPS adjustment plus potential additional adjustment for exceptional performance, positive MIPS adjustment, neutral payment adjustment, negative MIPS payment adjustment, and maximum negative MIPS payment adjustment. Study participants included ophthalmologists registered for Medicare Part B with participation in the Quality Payment Program (QPP) in PY 2019.

MAIN OUTCOMES AND MEASURES

Proportion of ophthalmologists qualifying for payment adjustments and payment adjustments.

RESULTS

For PY 2019, 76.5% of ophthalmologists (13 621) who registered for Medicare participated in the MIPS pathway of the QPP. Ophthalmologists practiced in a predominantly large metropolitan area (12 302; 90.3%). Roughly 99% of participants (11 182) received nonnegative reimbursement adjustments, and 92.6% (10 367) received positive adjustments. Ophthalmologists filing as individuals were less likely to achieve exceptional performance scores compared with those who had a filing category of advanced alternative payment model (APM; odds ratio [OR], 0.0003; 95% CI, 0.00002-0.00481) or group (OR, 0.21013; 95% CI, 0.19020-0.23215). When analyzing participating ophthalmologists with available Medicare payment data (11 193), a total of 8777 (78.4%) achieved exceptional MIPS scores corresponding to mean (SD) adjustments per physician of $244.60 ($217.36) to $4864.78 ($4323.08), or 0.07% ($2 146 835.21 of $3 212 011 252.88) to 1.33% ($42 698 166.89 of $3 212 011 252.88), of the total nondrug Medicare payment.

CONCLUSIONS AND RELEVANCE

Results of this economic evaluation showed that although 78.4% of ophthalmologists received exceptional positive payment adjustments, roughly 84% (798916 of 954615) of all health care professionals nationally achieved this benchmark. Exceptional MIPS was associated with filing as group or APM, resulting in, on average, a relatively small additional payment per participant; this suggests that ophthalmologists who file as individuals should consider an alternative filing approach. Changes in MIPS methodology may disproportionately affect certain ophthalmologists, which warrants further study.

摘要

重要性

Merit-Based Incentive Payment System（MIPS）旨在通过与质量相关的 Medicare 支付调整来促进高价值的医疗保健。

目的

评估 MIPS 评分和报告对眼科医生的经济评估。

设计、设置和参与者：在这项于 2021 年 10 月 10 日至 11 月 30 日进行的回顾性、横断面、多中心经济评估中，使用美国医疗保险和医疗补助服务中心（CMS）的公共数据文件评估了眼科医生的 MIPS 绩效和相关支付调整。参与者按报告隶属关系分层。使用报告的 CMS 方法和绩效年（PY）2019 支付百分比来估计以下类别的支付调整：积极的 MIPS 调整加上卓越绩效的潜在额外调整、积极的 MIPS 调整、中性支付调整、负 MIPS 支付调整和最大负 MIPS 支付调整。研究参与者包括在 PY 2019 年注册 Medicare 部分 B 并参加质量支付计划（QPP）的眼科医生。

主要结果和措施

有资格获得支付调整的眼科医生比例和支付调整。

结果

在 PY 2019 年，注册 Medicare 并参加 MIPS 途径的 QPP 的眼科医生中有 76.5%（13621 人）参加了该计划。眼科医生主要在大都市地区执业（12302 人，占 90.3%）。大约 99%的参与者（11182 人）获得了非负的报销调整，92.6%（10367 人）获得了积极的调整。与拥有高级替代支付模式（APM）的文件类别（优势比[OR]，0.0003；95%置信区间[CI]，0.00002-0.00481）或团体（OR，0.21013；95%CI，0.19020-0.23215）的人相比，以个人身份提交文件的眼科医生获得卓越绩效评分的可能性较小。当分析有可用 Medicare 支付数据的参与眼科医生（11193 人）时，共有 8777 人（78.4%）达到了卓越的 MIPS 评分，每位医生的平均（SD）调整为 244.60（217.36）美元至 4864.78（4323.08）美元，或 0.07%（2146835.21 美元至 3212011252.88 美元）至 1.33%（42698166.89 美元至 3212011252.88 美元），占非药物 Medicare 支付总额的 0.07%（2146835.21 美元至 3212011252.88 美元）至 1.33%（42698166.89 美元至 3212011252.88 美元），占非药物 Medicare 支付总额的 0.07%（2146835.21 美元至 3212011252.88 美元）至 1.33%（42698166.89 美元至 3212011252.88 美元），占非药物 Medicare 支付总额的 0.07%（2146835.21 美元至 3212011252.88 美元）至 1.33%（42698166.89 美元至 3212011252.88 美元）。

结论和相关性

这项经济评估的结果表明，尽管 78.4%的眼科医生获得了卓越的积极支付调整，但全国约 84%（954615 名中的 798916 名）的所有医疗保健专业人员都达到了这一基准。卓越的 MIPS 与作为团体或 APM 的文件相关，平均每位参与者获得相对较小的额外支付；这表明以个人身份提交文件的眼科医生应考虑采用替代提交方法。MIPS 方法的变化可能会不成比例地影响某些眼科医生，这需要进一步研究。