Dell Medical School, The University of Texas at Austin, Austin, TX.
Case Western Reserve University School of Medicine, Cleveland, OH.
JCO Oncol Pract. 2023 Jul;19(7):473-483. doi: 10.1200/OP.22.00858. Epub 2023 Apr 24.
The Merit-Based Incentive Payment System (MIPS) is currently the only federally mandated value-based payment model for oncologists. The weight of cost measures in MIPS has increased from 0% in 2017 to 30% in 2022. Given that cost measures are specialty-agnostic, specialties with greater costs of care such as oncology may be unfairly affected. We investigated the implications of incorporating cost measures into MIPS on physician reimbursements for oncologists and other physicians.
We evaluated physicians scored on cost and quality in the 2018 MIPS using the Doctors and Clinicians database. We used multivariable Tobit regression to identify physician-level factors associated with cost and quality scores. We simulated composite MIPS scores and payment adjustments by applying the 2022 cost-quality weights to the 2018 category scores and compared changes across specialties.
Of 168,098 identified MIPS-participating physicians, 5,942 (3.5%) were oncologists. Oncologists had the lowest cost scores compared with other specialties (adjusted mean score, 58.4 for oncologists 71.0 for nononcologists; difference, -12.66 [95% CI, -13.34 to -11.99]), while quality scores were similar (82.9 84.2; difference, -1.31 [95% CI, -2.65 to 0.03]). After the 2022 cost-quality reweighting, oncologists would receive a 4.3-point (95% CI, 4.58 to 4.04) reduction in composite MIPS scores, corresponding to a four-fold increase in magnitude of physician penalties ($4,233.41 US dollars [USD] in 2018 $18,531.06 USD in 2022) and greater reduction in exceptional payment bonuses compared with physicians in other specialties (-42.8% [95% CI, -44.1 to -41.5] for oncologists -23.6% [95% CI, -23.8 to -23.4] for others).
Oncologists will likely be disproportionally penalized after the incorporation of cost measures into MIPS. Specialty-specific recalibration of cost measures is needed to ensure that policy efforts to promote value-based care do not compromise health care quality and outcomes.
目前，基于价值的支付模式（MIPS）是唯一一项联邦政府授权的针对肿瘤学家的支付模式。MIPS 中的成本衡量标准的权重从 2017 年的 0%增加到 2022 年的 30%。鉴于成本衡量标准与专业无关，因此像肿瘤学这样护理成本较高的专业可能会受到不公平的影响。我们研究了将成本衡量标准纳入 MIPS 对肿瘤学家和其他医生的医师报销的影响。
我们使用医生和临床医生数据库评估了 2018 年 MIPS 中按成本和质量评分的医生。我们使用多变量 Tobit 回归来确定与成本和质量评分相关的医师水平因素。我们通过将 2022 年的成本-质量权重应用于 2018 年的类别评分，模拟了综合 MIPS 评分和支付调整，并比较了各专业的变化。
在确定的 168098 名参与 MIPS 的医生中，有 5942 名（3.5%）是肿瘤学家。与其他专业相比，肿瘤学家的成本评分最低（调整后的平均评分，肿瘤学家为 58.4，非肿瘤学家为 71.0；差异，-12.66[95%CI，-13.34 至-11.99]），而质量评分相似（82.9 84.2；差异，-1.31[95%CI，-2.65 至 0.03]）。在 2022 年成本-质量重新加权后，肿瘤学家的综合 MIPS 评分将降低 4.3 分（95%CI，4.58 至 4.04），这相当于医师罚款幅度增加了四倍（2018 年为 4233.41 美元[USD]，2022 年为 18531.06 美元[USD]），与其他专业的医生相比，特殊支付奖金的降幅更大（肿瘤学家为-42.8%[95%CI，-44.1 至-41.5]，其他人则为-23.6%[95%CI，-23.8 至-23.4]）。
在将成本衡量标准纳入 MIPS 后，肿瘤学家可能会受到不成比例的处罚。需要对成本衡量标准进行专业调整，以确保促进基于价值的护理的政策努力不会损害医疗质量和结果。
