Dow Division of Health Services Research, Department of Urology, University of Michigan, MI.
Dow Division of Health Services Research, Department of Urology, University of Michigan, MI.
Urology. 2022 Nov;169:84-91. doi: 10.1016/j.urology.2022.05.052. Epub 2022 Aug 3.
To determine the implications of the merit-based incentive payment system (MIPS) for urology practices. MIPS is a Medicare payment model that determines whether a physician is financially penalized or receives bonus payment based on performance in four categories: quality, practice improvement, promotion of interoperability, and spending.
We performed a cross-sectional analysis of urologist performance in MIPS for 2017 and 2019 using Medicare data. Urologist practice organization was categorized as single-specialty (small, medium, large) or multispecialty groups. MIPS scores were estimated by practice organization. Logistic regression models were used to examine the association between urology practice characteristics, including proportion of dual eligible beneficiaries, and bonus payment adjustment as defined by Medicare methodology. Rates of consolidation (movement from smaller to larger practices) between 2017 and 2019 were compared between those who were and those who were not penalized in 2017.
Urologists in small practices performed worse in MIPS and had a significantly lower adjusted odds ratio of receiving bonus payments in both 2017 and 2019 compared to larger group practices (odds ratio [OR] 0.04, 95% confidence interval [95%CI] 0.03-0.05 in 2017 and OR 0.37, 95%CI 0.30-0.47 in 2019). Increasing percent of dual eligible beneficiaries within a patient panel was associated with decreased odds of receiving bonus payment in both performance years. Urologists penalized in 2017 had higher rates of consolidation by 2019 compared to those who were not (14% vs 5%, P <.05).
Small urology practices and those caring for a higher proportion of dual eligible beneficiaries tended to perform worse in MIPS.
确定基于绩效的激励支付系统（MIPS）对泌尿科实践的影响。MIPS 是一种医疗保险支付模式，根据质量、实践改进、促进互操作性和支出四个方面的表现，决定医生是否受到经济处罚或获得奖金。
我们使用医疗保险数据对 2017 年和 2019 年泌尿科医生在 MIPS 中的表现进行了横断面分析。泌尿科医生的实践组织分为单一专业（小、中、大）或多专业团体。MIPS 评分由实践组织估算。使用逻辑回归模型检查泌尿科实践特征（包括双重合格受益人的比例）与医疗保险方法定义的奖金支付调整之间的关联。在 2017 年和 2019 年之间，比较了在 2017 年被处罚和未被处罚的医生之间的整合（从较小的实践向较大的实践转移）的比率。
小型实践中的泌尿科医生在 MIPS 中的表现较差，并且与大型实践相比，在 2017 年和 2019 年获得奖金的调整后优势比明显较低（优势比[OR]0.04，95%置信区间[95%CI]0.03-0.05 在 2017 年和 OR 0.37，95%CI 0.30-0.47 在 2019 年）。在患者群体中，双重合格受益人的比例增加与两个绩效年度获得奖金的几率降低相关。与未被处罚的医生相比，在 2017 年被处罚的泌尿科医生在 2019 年的整合率更高（14%比 5%，P<0.05）。
小型泌尿科实践和那些照顾更多双重合格受益人的实践在 MIPS 中表现较差。
