Incorporating Cost Measures Into the Merit-Based Incentive Payment System: Implications for Oncologists.

Autor:	Patel VR; Dell Medical School, The University of Texas at Austin, Austin, TX., Cwalina TB; Case Western Reserve University School of Medicine, Cleveland, OH., Nortj N; Section of Clinical Ethics, Department of Critical Care Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX., Mullangi S; Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY., Parikh RB; Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA.; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA., Shih YT; Section of Cancer Economics and Policy, Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX., Gupta A; Masonic Cancer Center, University of Minnesota, Minneapolis, MN., Hussaini SMQ; Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medicine, Baltimore, MD.
Jazyk:	angličtina
Zdroj:	JCO oncology practice [JCO Oncol Pract] 2023 Jul; Vol. 19 (7), pp. 473-483. Date of Electronic Publication: 2023 Apr 24.
DOI:	10.1200/OP.22.00858
Abstrakt:	Purpose: 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. Methods: 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. Results: 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 v 71.0 for nononcologists; difference, -12.66 [95% CI, -13.34 to -11.99]), while quality scores were similar (82.9 v 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 v $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 v -23.6% [95% CI, -23.8 to -23.4] for others). Conclusion: 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.
Databáze:	MEDLINE
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