Abstract
Purpose :
The Merit-based Incentive Payment System (MIPS) is intended to promote high value healthcare through quality-related Medicare payment adjustments. We sought to assess the economic impact of MIPS scoring and reporting category on ophthalmology providers.
Methods :
A retrospective, cross-sectional economic evaluation of MIPS performance and related payment adjustments was performed for ophthalmology providers registered for Medicare Part B with participation in the Quality Payment Program (QPP) in performance year (PY) 2019 using Centers for Medicare & Medicaid Service (CMS) public data files. Reported CMS methodology and PY 2019 payment percentages were used to estimate payment adjustments in USD for the following categories of MIPS scores: positive MIPS adjustment plus potential additional adjustment for exceptional performance (75.00-100.00 points), positive MIPS adjustment (30.01-74.99 points), neutral payment adjustment (30.00), negative MIPS payment adjustment (7.51-29.99 points), maximum negative MIPS payment adjustment (0-7.50 points).
Results :
For PY 2019, roughly 99% of providers received non-negative reimbursement adjustments and 92.6% received positive adjustments. Participants submitted data through MIPS eligibility categories of Advanced Alternative Payment Models (APM) (2102, 15.43%), Group (8369, 61.44%), Individual (3144, 23.08%), and Virtual Group (6, 0.04%). The total average MIPS score differed statistically significantly by filing category for APM, Group, and Individual providers with average scores of 95.39 (3.17), 86.04 (15.12), and 68.72 (28.74), respectively (p < .001). Individuals were significantly less likely to achieve exceptional performance (75.00-100.00) than APM and Group participants with OR 0.0003 (95% CI 0.00002- 0.00481) and OR 0.21013 (95% CI 0.19020-0.23215), respectively. The estimated total national payment adjustment ranges for ophthalmology providers for PY 2019 were $2,146,835 to $42,698,167, $0 to $19,960, -$41 to -$28,347, and -$83,544 to -$83,544 for those with exceptional performance, positive performance, negative, and maximum negative performance, respectively.
Conclusions :
There are differences in MIPS scores across filing entities, and the specific scoring methodology may be responsible for meaningful economic incentives as performance thresholds become increasingly rigorous in subsequent years.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.