MIPS in Residency? A Look at Merit-Based Incentives in an Internal Medicine Residency Outpatient Practice

Abstract

Background: In January 2017, full implementation of the Medicare Access and CHIP Reauthorization Act (MACRA) Merit-based Incentive Payment System (MIPS) inspired us to introduce a similar incentivized model of value-based care into our internal medicine residency's outpatient practice.

Objective: To provide real-world experience in a value-based payment practice model, we provided monetary incentives to internal medicine residents for meeting inbox management expectations, timely reporting, and improvement in clinical outcome measures.

Methods: Thirty-seven residents were divided into 6 teams. Over a 5-month period, clinical goals were to reduce by 5% each teams' average number of patients with diabetes who had HbA1c > 9% and to raise by 10% the number of diabetes patients at target blood pressure. Goals for inbox management were established: all forms, notes, medication refills, and patient requests were expected to be complete at the end of each week. Teams received monetary bonuses based on compliance with reporting, management of inboxes, and progress toward clinical outcome goals.

Results: Every team improved their patients' blood pressure; however, no one reached the 10% target. Every team improved their patients' average HbA1c, and 2 teams surpassed the 5% goal. All teams met their weekly reporting goal, and half completed the inbox management tasks 100% of the time. Of the 26 participants who completed the survey, 22 (85%) favored continuing the program.

Conclusions: Providing monetary incentives in a team-based internal medicine residency model improved patient outcome measures and provided real-world exposure to incentivized value-based care.

Figure

Nursing Algorithm and Resident Cross-Coverage Guide Abbreviations: PCP, primary care physician; RCP, respiratory care practitioner. ^a Residents scheduled on medical intensive care unit, cardiology, vacation, away rotation, or night float are generally unavailable for texts and pages. Use your judgment. ^b Ambulatory officer is on-call each day for urgent patient care needs when primary care physician is unavailable.