Objective
To determine the implications of the merit-based incentive payment system (MIPS) for
urology practices. MIPS is a Medicare payment model that determines whether a physician
is financially penalized or receives bonus payment based on performance in four categories:
quality, practice improvement, promotion of interoperability, and spending.
Methods
We performed a cross-sectional analysis of urologist performance in MIPS for 2017
and 2019 using Medicare data. Urologist practice organization was categorized as single-specialty
(small, medium, large) or multispecialty groups. MIPS scores were estimated by practice
organization. Logistic regression models were used to examine the association between
urology practice characteristics, including proportion of dual eligible beneficiaries,
and bonus payment adjustment as defined by Medicare methodology. Rates of consolidation
(movement from smaller to larger practices) between 2017 and 2019 were compared between
those who were and those who were not penalized in 2017.
Results
Urologists in small practices performed worse in MIPS and had a significantly lower
adjusted odds ratio of receiving bonus payments in both 2017 and 2019 compared to
larger group practices (odds ratio [OR] 0.04, 95% confidence interval [95%CI] 0.03-0.05
in 2017 and OR 0.37, 95%CI 0.30-0.47 in 2019). Increasing percent of dual eligible
beneficiaries within a patient panel was associated with decreased odds of receiving
bonus payment in both performance years. Urologists penalized in 2017 had higher rates
of consolidation by 2019 compared to those who were not (14% vs 5%, P <.05).
Conclusion
Small urology practices and those caring for a higher proportion of dual eligible
beneficiaries tended to perform worse in MIPS.
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Article Info
Publication History
Published online: August 02, 2022
Accepted:
May 8,
2022
Received:
March 9,
2022
Footnotes
Funding Disclosure: Avinash Maganty and Lillian Lai are supported by funding from National Cancer Institute Advanced Training in Urologic Oncology T32 Grant No T32CA180984.
Brent Hollenbeck and Vahakn Shahinian are supported by research funding from AHRQ (RO1 HS025707).
Identification
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