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UPJ Insight: Urologist Scores in the Era of the Merit-Based Incentive Payment System (MIPS)
By: Ridwan Alam, MD, MPH; Marisa M. Clifton, MD, MPH; Misop Han, MD | Posted on: 01 Mar 2022
Alam R, Clifton MM and Han M: Urologist scores in the era of the merit-based incentive payment system (MIPS). Urol Pract 2022; https://doi.org/10.1097/UPJ.0000000000000285.
Study Need and Importance: The transition from fee-for-service to value-based payment introduces a new set of challenges and opportunities for the practicing physician. It is unknown how urologists have been impacted by the recent implementation of the merit-based incentive payment system (MIPS), which is mandatory for all physicians treating patients insured by Medicare. We describe the MIPS performance scores of urologists and investigate their association with practice patterns.
What We Found: Urologists in group practices scored higher than urologists in individual practices across all MIPS categories except cost: urologists in alternative payment models often scored even higher (see figure). Preference for group practice or alternative payment models was more common among urologists who graduated medical school more recently. Geographic location also appears to be a contributing factor when evaluating practice type.
Limitations: This study examined the MIPS scores for physicians in performance year 2018, which was the final year of the voluntary transition period. Therefore, it is possible that this cohort is biased toward physicians who are more motivated to adapt and learn the system to maximize scores. In addition, specific practices and techniques enacted by physicians to obtain higher scores could not be elucidated from these data. Factors like physician incentives, additional income, pay structures and state-level variations in compensation also could not be evaluated.
Interpretation for Patient Care: These data provide a framework which urologists may wish to consider when starting practice. Although Medicare represents only 1 payer, most urology practices depend on Medicare claims to some extent due to the patient population of this specialty. Urologists in an individual practice did not score as well as their colleagues who practiced in a group environment, which may foreshadow health care delivery patterns in the future.
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