Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan.
Division of Urology, Santa Clara Valley Medical Center, San Jose, California.
Urol Pract. 2023 May;10(3):245-252. doi: 10.1097/UPJ.0000000000000392. Epub 2023 Mar 2.
Most urologists are required to participate in Merit-based Incentive Payment System-an alternative payment model in which physicians must track and report quality measures. However, Merit-based Incentive Payment System measures are urology-specific, and it remains unclear what measures urologists are choosing to track and report.
We performed a cross-sectional analysis of Merit-based Incentive Payment System measures reported by urologists for the most recent performance year. Urologists were categorized by their reporting affiliation (ie, individual, group, or alternative payment model). We identified the measures most frequently reported by urologists. Among reported measures, we identified those that were specific to urological conditions and those that were "topped out" (ie, measures considered indiscriminate by Medicare because high performance is easily achieved).
A total of 6,937 urologists reported in Merit-based Incentive Payment System during the 2020 performance year, of whom 14% reported as an individual, 56% as a group, and 30% as an alternative payment model. Among the top 10 most frequently reported measures, none were urology-specific. Eleven percent of urologists reported measures that were directly specific to urological conditions; 65% of individual urologists, 58% of those in groups, and 92% in alternative payment models reported at least 1 or more "topped out" measures.
Most measures reported by urologists are not specific to urological conditions, and therefore performance within Merit-based Incentive Payment System may be a poor indicator of the quality of urological care provided. As Medicare transitions Merit-based Incentive Payment System to implement specific quality measures, the urological community will need to develop and submit measures that will be most impactful for urology patients.
大多数泌尿科医生都需要参与基于绩效的激励支付系统（一种替代支付模式，医生必须跟踪和报告质量措施）。然而，基于绩效的激励支付系统的衡量标准是针对泌尿科的，目前尚不清楚泌尿科医生选择跟踪和报告哪些衡量标准。
我们对泌尿科医生在最近的绩效年度报告的基于绩效的激励支付系统衡量标准进行了横断面分析。泌尿科医生按其报告隶属关系（即个人、团体或替代支付模式）进行分类。我们确定了泌尿科医生最常报告的措施。在报告的措施中，我们确定了那些专门针对泌尿科疾病的措施和那些“封顶”的措施（即 Medicare 认为不区分的措施，因为很容易达到高绩效）。
共有 6937 名泌尿科医生在 2020 年的绩效年度内报告了基于绩效的激励支付系统，其中 14%作为个人报告，56%作为团体报告，30%作为替代支付模式报告。在报告的前 10 项最常报告的措施中，没有一项是针对泌尿科的。11%的泌尿科医生报告了直接针对泌尿科疾病的措施；65%的个体泌尿科医生、58%的团体泌尿科医生和 92%的替代支付模式泌尿科医生报告了至少 1 项或更多的“封顶”措施。
泌尿科医生报告的大多数措施都不是专门针对泌尿科疾病的，因此基于绩效的激励支付系统内的表现可能是提供泌尿科护理质量的一个很差的指标。随着医疗保险向基于绩效的激励支付系统过渡，以实施具体的质量措施，泌尿科界将需要制定和提交对泌尿科患者最具影响力的措施。
