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Insights from the Field: How Do Doctors Think the MIPS program improves value?

In a recent analysis published in the American Journal of Accountable Care, VSSL members Leah Marcotte, Lingmei Zhou, and Joshua Liao described results from a survey study evaluating physician perspectives about how the Merit-based Incentive Payment System (MIPS) improves value.



Rationale:

  • MIP represents the largest pay-for-performance program to date in the United States. Through MIPS, Medicare engages more than 1 million clinicians caring for Medicare beneficiaries around the country and uses financial incentives to encourage these clinicians to deliver higher-quality and more cost-conscious (ie, higher-value) care.

  • In the MIPS program, clinicians are evaluated in 4 domains: quality (eg, reporting and performance on clinical quality measures), improvement activities, promoting interoperability (eg, using health information technology to improve care), and cost.

  • Physicians must be engaged stakeholders for MIPS to succeed, and many physicians believe that core activities in the 4 domains can improve value (ie, improve quality while maintaining or lowering costs, or lower costs while maintaining or improving quality).

  • However, value is inherently multifaceted, given its relationship to the underlying mechanisms of quality, cost, and patient experience.

Results:

  • Of 1431 physicians, 51% responded. Most believed that value would be improved by activities in the 4 MIPS domains of quality (55%), improvement activities (70%), promoting interoperability (54%), and cost (71%)

  • Process quality was the most frequently selected driver in the quality (77%), improvement activities (70%), and promoting interoperability (70%) domains


Conclusion: Among physicians who believed that MIPS domain activities would improve value, most believed that would occur predominantly through process improvement activities rather than other forms of quality, patient experience, or cost containment.


These findings complement a portfolio of work led by Dr. Liao about MIPS, including analyses of physician perspectives and performance among group practices; and insights about the financial opportunities and clinician engagement in the program, and other aspects of participation (MIPS APM designation; small group practice participation; the need for more cost measures).