Division of Health Policy and Economics, Department of Population Health Sciences, Weill Cornell Medical College, New York, New York.
Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York.
JAMA Health Forum. 2021 May 14;2(5):e210527. doi: 10.1001/jamahealthforum.2021.0527. eCollection 2021 May.
The Merit-based Incentive Payment System (MIPS) is a major Medicare value-based purchasing program, influencing payment for more than 1 million clinicians annually. There is a growing concern that MIPS increases administrative burden, and little is known about what it costs physician practices to participate in the program.
To examine the costs for independent physician practices to participate in MIPS in 2019.
This qualitative study identified and interviewed leaders of physician practices participating in the US Centers for Medicare & Medicaid Services (CMS) MIPS program, including those in MIPS alternative payment models. Time required and financial costs were calculated from responses to in-depth, semistructured interviews conducted from December 12, 2019, to June 23, 2020. Physician practices were categorized by size (small, 1-9 physicians; medium, 10-25; and large, ≥50), specialty (primary care, general surgery, or multispecialty), and US census region. Participants were asked about 2019 costs related to clinician and staff time, information technology, and external vendors. Time was converted to financial costs using the Medical Group Management Association's Provider Compensation and the Management and Staff Compensation databases.
Annual time spent by staff on MIPS-related activities and mean per-physician costs to physician practices in 2019.
Leaders of 30 physician practices (9 [30.0%] small primary care, 6 [20.0%] small general surgery, 4 [13.3%] medium primary care, 4 [13.3%] medium general surgery, and 7 [23.3%] large multispecialty) represented all US census regions, and 14 of the 30 (46.7%) practices participated in a MIPS alternative payment model in 2019. The mean per-physician cost to practices of participating in MIPS was $12 811 (interquartile range [IQR], $2861-$17 715). Physicians, clinical staff, and administrative staff together spent 201.7 (IQR, 50.9-295.2) hours annually per physician on MIPS-related activities. Medical assistants and nursing staff together spent a mean of 99.2 (IQR, 0-163.3) hours per physician each year; frontline physicians spent 53.6 (IQR, 0.6-55.8) hours; executive administrators spent 28.6 (IQR, 3.1-26.7) hours; other clinicians and staff spent a combined 20.3 (IQR, 0-36.8) hours. Physician time accounted for the greatest proportion of overall MIPS-related costs (54%; $6909; IQR, $94-$9905).
In this qualitative study, physician practice leaders reported significant time and financial costs of participating in the MIPS program. Attention to reducing the burden of MIPS may be warranted.
重要性：Merit-based Incentive Payment System（MIPS）是 Medicare 基于价值的采购计划的主要组成部分，每年影响超过 100 万临床医生的支付。越来越多的人担心 MIPS 会增加行政负担，但对于医生实践参与该计划的成本知之甚少。
目的：研究 2019 年独立医生实践参与 MIPS 的成本。
设计：本定性研究确定并采访了参与美国医疗保险和医疗补助服务中心（CMS）MIPS 计划的医生实践的领导者，包括参与 MIPS 替代支付模式的医生实践。从 2019 年 12 月 12 日至 2020 年 6 月 23 日进行深入的半结构化访谈，计算了所需时间和财务成本。根据医生数量（小型，1-9 名医生；中型，10-25 名；大型，≥50 名）、专业（初级保健、普通外科或多专业）和美国人口普查区对医生实践进行了分类。参与者被问及 2019 年与临床医生和员工时间、信息技术和外部供应商相关的成本。使用医疗集团管理协会的提供者补偿和管理及员工补偿数据库将时间转换为财务成本。
主要结果和措施：2019 年员工在 MIPS 相关活动上花费的时间以及每位医生的医生实践平均成本。
结果：30 名医生实践的领导者（9 名[30.0%]小型初级保健，6 名[20.0%]小型普通外科，4 名[13.3%]中型初级保健，4 名[13.3%]中型普通外科和 7 名[23.3%]大型多专业）代表了所有美国人口普查区，其中 30 名中的 14 名（46.7%）实践在 2019 年参与了 MIPS 替代支付模式。参与 MIPS 的实践的每位医生的平均成本为 12811 美元（四分位距[IQR]，2861-17715 美元）。医生、临床工作人员和行政人员每年共同为 MIPS 相关活动花费每位医生 201.7（IQR，50.9-295.2）小时。医疗助理和护士每年总共花费每位医生 99.2（IQR，0-163.3）小时；一线医生花费 53.6（IQR，0.6-55.8）小时；行政管理人员花费 28.6（IQR，3.1-26.7）小时；其他临床医生和工作人员总共花费 20.3（IQR，0-36.8）小时。医生时间占 MIPS 相关成本的最大比例（54%；6909 美元；IQR，94-9905 美元）。
结论：在这项定性研究中，医生实践领导者报告了参与 MIPS 计划的大量时间和财务成本。可能需要关注减轻 MIPS 的负担。
