Researchers Find Narrow But Substantive Link Between MIPS Scores, Hospital Compare Scores
Can better physician performance on the MIPS [Merit-Based Incentive Payment System] quality score actually be correlated directly with better hospital outcomes, as expressed in CMS Hospital Compare data collected by the Centers for Medicare and Medicaid Services?
A new investigative commentary published on August 3 online in the JAMA Network, “Association Between the Physician Score in the Merit-Based Incentive Payment System and Hospital Performance in Hospital Compare in the First Year of the Program,” authored by researchers Laurent G. Glance, M.D., Caroline P. Thirukumaran, Ph.D., Changyong Feng, Ph.D., Stewart J. Lustik, M.D., and Andrew W. Dick, Ph.D., aimed to find out the answer.
Dr. Glance et al performed a cross-sectional study of 38,830 physicians used 2017 Physician Compare data, and merging it with CMS Hospital Compare data, with the team conducting their data analysis from September to November 2020.
In fact, the answer turned out to be yes, that, “In this study, better performance on the physician MIPS quality score was associated with better hospital surgical outcomes for some physician specialties during the first year of MIPS.”
As the researchers write in their article, “Performance measurement is the centerpiece of the Center for Medicare & Medicaid Services (CMS) efforts to redesign the US health care system to deliver better patient outcomes at a lower cost. Under the 2015 Medicare Access and Children’s Reauthorization Act, CMS created the Quality Payment Program, which mandates that eligible clinicians participate in either the Merit-Based Incentive Payment System (MIPS) or Advanced Alternative Payment Models. Physicians, as either individuals or groups of physicians, are evaluated in the MIPS using a composite score between 0 and 100 points based on quality, improvement activities, and promoting interoperability. They can receive a maximum of 60 points for quality (10 points for each of 6 measures). The validity of the quality component of the MIPS score for comparing clinician performance has been challenged for several reasons,” they note, including the fact that, though physicians are required to report on six quality measures, they are allowed to select any six measures from the list of 271 available measures, while the Hospital Compare program uses a standard set of uniform metrics, including mortality and readmissions. Also, physicians in MIPS can select the measures on which they perform best; and, in addition, of the six measures required, only one is required to be an outcomes measure, while the others can be process measures. That, they note, makes any kind of analysis challenging to make meaningful. What’s more, the “MIPS quality score has not been previously evaluated for surgical care.”
What’s more, the researchers note that “We found limited evidence to support the empirical validity of the MIPS quality component for surgical patients. MIPS quality scores for vascular surgeons and anesthesiologists were associated with small but clinically meaningful differences in one global measure of hospital performance, the failure-to-rescue rate. MIPS quality scores for other surgical specialties and intensivists were not associated with either failure-to-rescue rates or postoperative complications.” Still, they write, “When we focused instead on specific surgeries, we found that MIPS quality scores for cardiac surgeons were associated with small and clinically meaningful differences in hospital rates of CABG 30-day mortality and readmissions, while orthopedic surgeon MIPS scores were not associated with hospital rates of complications after hip and knee replacements. Finally, when we examined specific complications included in the postoperative complication measure, we found that lower MIPS quality scores for general surgeons and orthopedic surgeons were associated with higher rates of postoperative respiratory failure, while lower MIPS quality scores were associated with higher rates of postoperative sepsis for thoracic surgeons.”
Analyzing the data, the researchers come to the conclusion that “It is perhaps not surprising that physician MIPS scores are, at best, only weakly associated with hospital performance. There are several possible explanations for this, including the unusually high number of physicians with very high MIPS scores, the preponderance of process measures as opposed to outcome measures, the lack of specialty-specific mandatory measurement sets, the absence of a fixed data submission period, and scoring adjustments by CMS unrelated to physician performance.”
Ultimately, the authors conclude, “In this cross-sectional study, we found limited evidence to show that better performance on the physician MIPS quality score was associated with lower rates of hospital complications in surgical patients during the first year of MIPS. Concerns have been raised that MIPS may not sufficiently incentivize physicians to deliver high-value care. However, the main problem with MIPS may not be whether the incentives are large enough to influence physician behavior but rather whether the MIPS quality score is scientifically valid and measures physicians’ contribution to outcomes.”