MIPS proving a financial boon for system-affiliated doctors

Doctors looking to earn more under Medicare’s Merit-based Incentive Payment System (MIPS) would likely benefit from working in a practice affiliated with a hospital system.

A recently-published study in JAMA finds that doctors in system-affiliated practices earned substantially higher MIPS scores in 2019 than those in independent practice, and were thus more likely to receive upward payment adjustments and quality bonuses.

Researchers looked at publicly reported data from more than 635,000 clinicians working at outpatient clinics, divided nearly evenly between those affiliated with a health system and those who weren’t. They found that the mean of final MIPS scores for system-affiliated physicians was 79 on a scale of 0-100, compared with 60.3 for doctors in non-affiliated practices.

In addition, 97% of doctors in affiliated practices received a positive payment adjustment, compared with about 83% of those in independent practice. while 74% of affiliated doctors received a financial bonus from Medicare, compared with 55% of non-affiliated doctors.

Conversely, slightly under 14% of independent practitioners received a negative payment adjustment, versus about 3% of doctors in affiliated practices.

The authors note that the overall difference in scores is due in part to system-affiliated clinicians receiving better scores on measures tied to technology use. For example, more than 52% of affiliated clinicians reported using electronic prescribing, compared with about 25% of non-affiliated clinicians. Mean performance scores for that measure were 89.4 and 84.9, respectively.

Similarly, about 52% of affiliated doctors reported providing patient-specific education and a mean performance score for the measure of 72, compared with 24%reporting and mean performance of 54 for unaffiliated clinicians.

The authors speculate that higher reporting rates and mean scores in the technology-based MIPS categories result from the support that health systems are able to provide their constituent practices. Consequently, they say, “health system affiliation may provide needed technology and management infrastructure that helps clinicians succeed across a range of metrics under value-based payments.”

The study, “Association of Clinician Health System Affiliation With Outpatient Performance Ratings in the Medicare Merit-based Incentive Payment System” appears in the September 8 issue of JAMA.