The James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Urol Pract. 2022 Mar;9(2):119-125. doi: 10.1097/UPJ.0000000000000285. Epub 2022 Jan 24.
The shift from fee-for-service to value-based payment introduces a new set of challenges and opportunities for the practicing physician. It is unknown how urologists have been impacted by the recent implementation of the merit-based incentive payment system (MIPS). We describe the MIPS performance scores of urologists and investigate their association with practice patterns.
Urologists were identified in the 2018 MIPS performance score database and classified by participation status: individual practice, group practice or alternative payment model (APM). The overall MIPS score is comprised of 4 categories: quality, promoting interoperability, cost and improvement activities. Comparative statistics were performed using Tukey's honest significance test and chi-square analysis. Multinomial logistic regression was performed to test associations.
A total of 9,055 urologists were included with the following average scores: quality 82.5, promoting interoperability 88.9, cost 74.4, improvement activities 37.3 and overall 86.9. When stratified by participation status, urologists in group practices scored higher than individual urologists in each category except cost; urologists in APMs often scored even higher. Preference for group practice or APMs was more common among urologists who graduated medical school more recently. Geographic location also appears to be a contributing factor when evaluating practice type.
Urologists who participated as a group practice or APM scored higher across most MIPS categories than those in an individual practice. Introduction of a new reimbursement schedule will likely result in further evolution of practice patterns in the future.
从按服务收费向基于价值的支付转变给执业医师带来了一系列新的挑战和机遇。目前尚不清楚最近实施的基于绩效的激励支付系统 (MIPS) 对泌尿科医生有何影响。我们描述了泌尿科医生的 MIPS 绩效评分，并调查了它们与实践模式的关联。
在 2018 年 MIPS 绩效评分数据库中确定泌尿科医生的身份，并根据参与状态进行分类：个体实践、团体实践或替代支付模式 (APM)。总体 MIPS 评分由 4 个类别组成：质量、促进互操作性、成本和改进活动。使用 Tukey 的诚实显著性检验和卡方分析进行比较统计。使用多项逻辑回归检验关联。
共纳入 9055 名泌尿科医生，平均评分如下：质量 82.5、促进互操作性 88.9、成本 74.4、改进活动 37.3 和总体 86.9。按参与状态分层，除了成本外，团体实践中的泌尿科医生在每个类别中的得分都高于个体泌尿科医生；而 APM 中的泌尿科医生得分通常更高。最近毕业的泌尿科医生更倾向于选择团体实践或 APM。地理位置在评估实践类型时似乎也是一个影响因素。
作为团体实践或 APM 参与的泌尿科医生在大多数 MIPS 类别中的得分都高于个体实践。新报销计划的引入可能会导致未来实践模式的进一步演变。
