Implications of the Merit-Based Incentive Payment System for Urology Practices


      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.


      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.


      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).


      Small urology practices and those caring for a higher proportion of dual eligible beneficiaries tended to perform worse in MIPS.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Anon: Merit-based Incentive Payment System (MIPS) overview-QPP. 2021. Available at:, accessed November 15, 2021.

        • Kapoor DA
        • Shore ND
        • Kirsh GM
        • et al.
        The LUGPA alternative payment model for initial therapy of newly diagnosed patients with organ-confined prostate cancer: rationale and development.
        Rev Urol. 2017; 19: 235-245
      2. Anon: Congress should replace medicare's merit-based incentive payment system | health affairs blog. Available at:, accessed December 18, 2021.

        • Khullar D
        • Bond AM
        • O'Donnell EM
        • et al.
        Time and financial costs for physician practices to participate in the medicare merit-based incentive payment system: a qualitative study.
        JAMA Health Forum. 2021; 2e210527
        • Khullar D
        • Burke GC
        • Casalino LP
        Can small physician practices survive?: sharing services as a path to viability.
        JAMA. 2018; 319: 1321-1322
        • Muhlestein DB
        • Smith NJ
        Physician consolidation: rapid movement from small to large group practices, 2013–15.
        Health Aff (Millwood). 2016; 35: 1638-1642
        • George S
        • Daniels K
        • Fioratou E
        A qualitative study into the perceived barriers of accessing healthcare among a vulnerable population involved with a community center in Romania.
        Int J Equity Health. 2018; 17: 41
        • Casalino LP
        • Khullar D
        Value-based purchasing and physician professionalism.
        JAMA. 2019; 322: 1647-1648
        • Desai NR
        • Ross JS
        • Kwon JY
        • et al.
        Association between hospital penalty status under the hospital readmission reduction program and readmission rates for target and nontarget conditions.
        JAMA. 2016; 316: 2647-2656
        • Roberts ET
        • Zaslavsky AM
        • McWilliams JM
        The value-based payment modifier: program outcomes and implications for disparities.
        Ann Intern Med. 2018; 168: 255-265
      3. Anon: Support for small, underserved, and rural practices - QPP. Available at:, accessed December 10, 2021.

      4. Anon: Medicare data on provider practice and specialty (MD-PPAS) | ResDAC. Available at:, accessed December 10, 2021.

        • Modi PK
        • Yan P
        • Hollenbeck BK
        • et al.
        Urologist practice structure and quality of prostate cancer care.
        Urol Pract. 2020; 7: 419-424
      5. Anon: Doctors and clinicians | Provider data catalog. Available at:, accessed December 10, 2021.

      6. Anon: Medicare provider utilization and payment data: physician and other supplier | CMS. Available at:, accessed December 10, 2021.

        • Modi PK
        • Kaufman SR
        • Herrel LA
        • et al.
        Practice-level adoption of conservative management for prostate cancer.
        J Oncol Pract. 2019; 15: e863-e869
        • Gronbeck C
        • Feng PW
        • Feng H
        Participation and performance of dermatologists in the 2017 merit-based incentive payment system.
        JAMA Dermatol. 2020; 156: 466-468
        • Miller LE
        • Kondamuri NS
        • Xiao R
        • et al.
        Otolaryngologist performance in the merit-based incentive payment system in 2018.
        Otolaryngol–Head Neck Surg Off J Am Acad Otolaryngol-Head Neck Surg. 2021; 166 (1945998211032896)
        • Cwalina TB
        • Jella TK
        • Acuña AJ
        • et al.
        How did orthopaedic surgeons perform in the 2018 centers for medicaid and medicare services merit-based incentive payment system?.
        Clin Orthop. 2021; 480: 8-22
        • Vamos EP
        • Pape UJ
        • Bottle A
        • et al.
        Association of practice size and pay-for-performance incentives with the quality of diabetes management in primary care.
        CMAJ Can Med Assoc J J Assoc Medicale Can. 2011; 183: E809-E816
        • Ng CWL
        • Ng KP
        Does practice size matter? Review of effects on quality of care in primary care.
        Br J Gen Pract J R Coll Gen Pract. 2013; 63: e604-e610
        • Khullar D
        • Bond AM
        • Qian Y
        • et al.
        Physician Practice Leaders’ Perceptions of Medicare's Merit-Based Incentive Payment System (MIPS).
        J Gen Intern Med. 2021; 36: 1-7
        • Kauffman DM
        • Borden WB
        • Choi BG
        Maximizing Performance in Medicare's merit based incentive payment system: a financial model to optimize health information technology resource allocation.
        Inq J Med Care Organ Provis Financ. 2020; 57 (0046958020971237)
        • Khullar D
        • Schpero WL
        • Bond AM
        • et al.
        Association between patient social risk and physician performance scores in the first year of the merit-based incentive payment system.
        JAMA. 2020; 324: 975-983
        • Byrd JN
        • Chung KC
        Evaluation of the merit-based incentive payment system and surgeons caring for patients at high social risk.
        JAMA Surg. 2021; (accessed August 24, 2021)
        • Muhlestein DB
        • Smith NJ
        Physician consolidation: rapid movement from small to large group practices, 2013-15.
        Health Aff Proj Hope. 2016; 35: 1638-1642
        • Machta RM
        • Maurer KA
        • Jones DJ
        • et al.
        A systematic review of vertical integration and quality of care, efficiency, and patient-centered outcomes.
        Health Care Manage Rev. 2019; 44: 159-173
        • Roberts ET
        • Mehrotra A
        • McWilliams JM
        High-price and low-price physician practices do not differ significantly on care quality or efficiency.
        Health Aff Proj Hope. 2017; 36: 855-864
        • Baker LC
        • Bundorf MK
        • Kessler DP
        The effect of hospital/physician integration on hospital choice.
        Nat Bureau Econom Res. 2015; (Available at:) (accessed December 24, 2021)