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. 2022 Jan;29(1):64-72.
doi: 10.1111/acem.14373. Epub 2021 Sep 7.

Emergency clinician participation and performance in the Centers for Medicare & Medicaid Services Merit-based Incentive Payment System

Cameron J Gettel  1   2 , Christopher R Han  3 , Michael A Granovsky  4 , Carl T Berdahl  5 , Keith E Kocher  6   7   8 , Abhishek Mehrotra  9 , Jeremiah D Schuur  10 , Amer Z Aldeen  11 , Richard T Griffey  12 , Arjun K Venkatesh  1   13
Affiliations

Emergency clinician participation and performance in the Centers for Medicare & Medicaid Services Merit-based Incentive Payment System

Cameron J Gettel et al. Acad Emerg Med. 2022 Jan.

Abstract

Background: The Merit-based Incentive Payment System (MIPS) is the largest national pay-for-performance program and the first to afford emergency clinicians unique financial incentives for quality measurement and improvement. With little known regarding its impact on emergency clinicians, we sought to describe participation in the MIPS and examine differences in performance scores and payment adjustments based on reporting affiliation and reporting strategy.

Methods: We performed a cross-sectional analysis using the Centers for Medicare & Medicaid Services 2018 Quality Payment Program (QPP) Experience Report data set. We categorized emergency clinicians by their reporting affiliation (individual, group, MIPS alternative payment model [APM]), MIPS performance scores, and Medicare Part B payment adjustments. We calculated performance scores for common quality measures contributing to the quality category score if reported through qualified clinical data registries (QCDRs) or claims-based reporting strategies.

Results: In 2018, a total of 59,828 emergency clinicians participated in the MIPS-1,246 (2.1%) reported as individuals, 43,404 (72.5%) reported as groups, and 15,178 (25.4%) reported within MIPS APMs. Clinicians reporting as individuals earned lower overall MIPS scores (median [interquartile range {IQR}] = 30.8 [15.0-48.2] points) than those reporting within groups (median [IQR] = 88.4 [49.3-100.0]) and MIPS APMs (median [IQR] = 100.0 [100.0-100.0]; p < 0.001) and more frequently incurred penalties with a negative payment adjustment. Emergency clinicians had higher measure scores if reporting QCDR or QPP non-emergency medicine specialty set measures.

Conclusions: Emergency clinician participation in national value-based programs is common, with one in four participating through MIPS APMs. Those employing specific strategies such as QCDR and group reporting received the highest MIPS scores and payment adjustments, emphasizing the role that reporting strategy and affiliation play in the quality of care.

Keywords: Merit-Based Incentive Payment System; payment; population health; qualified clinical data registry; quality measurement.

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Figures

Figure 1.
Figure 1.
Analytic sample for emergency clinicians and quality measures Abbreviations: APM, alternative payment model; EM, emergency medicine; MIPS, Merit-based Incentive Payment System Note: Table 1, Table 2, and Figure 2 include the derived analytic sample above the dashed line. Table 3, assessing quality measure scoring within the Quality category, includes the derived analytic sample below the dashed line.
Figure 2.
Figure 2.
Merit-based Incentive Payment System (MIPS) reporting affiliation and payment adjustments for emergency clinicians Abbreviations: APM, alternative payment model; MIPS, Merit-based Incentive Payment System
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References

    1. Dowd B, Li C, Swenson T, Coulam R, Levy J. Medicare’s Physician Quality Reporting System (PQRS): quality measurement and beneficiary attribution. Medicare Medicaid Res Rev 2014;4(2):eCollection 2014. - PMC - PubMed
    1. Hirsch JA, Leslie-Mazwi TM, Nicola GN, et al. PQRS and the MACRA: value-based payments have moved from concept to reality. AJNR Am J Neuroradiol 2016;37(12):2195–2200. - PMC - PubMed
    1. Centers for Medicare & Medicaid Services, HHS. Medicare program; Merit-based Incentive Payment System (MIPS) and Alternative Payment Model (APM) incentive under the physician fee schedule, and criteria for physician-focused payment models. Final rule with comment period. Fed Regist 2016;81(214):77008–831. - PubMed
    1. Centers for Medicare & Medicaid Services. Quality Payment Program – MIPS Overview. https://qpp.cms.gov/mips/overview. Accessed December 3, 2020.
    1. Centers for Medicare & Medicaid Services. Quality Payment Program – Resource Library. https://qpp.cms.gov/about/resource-library. Accessed December 3, 2020.

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