Adjustment For Social Risk Factors Does Not Meaningfully Affect Performance On Medicare's MIPS Clinician Cost Measures

Medicare's Merit-based Incentive Payment System (MIPS) includes episode-based cost measures that evaluate Medicare expenditures for specific conditions and procedures. These measures compare clinicians' cost performance and, along with other MIPS category scores, determine Medicare Part B...

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Bibliographic Details
Published in:Health affairs (Millwood, Va.) Va.), 2020-09, Vol.39 (9), p.1495-16
Main Authors: Sandhu, Alexander T, Bhattacharya, Jay, Lam, Joyce, Bounds, Sam, Luo, Binglie, Moran, Daniel, Uwilingiyimana, Aimée-Sandrine, Fenson, Derek, Choradia, Nirmal, Do, Rose, Feinberg, Laurie, MaCurdy, Thomas, Nagavarapu, Sriniketh
Format: Article
Language:English
Subjects:
Adjustment
At risk populations
Beneficiaries
Capitation
Chronic illnesses
Colonoscopy
Comorbidity
Complex patients
Cost analysis
Costs
Disease
Ethnicity
Expenditures
Fair Labor Standards Act 1938-US
Government programs
Health care access
Health care expenditures
Health care policy
Low income groups
Medicaid
Medicare
Mortality
Patients
Payment systems
Pneumonia
Quality
Risk adjustment
Risk analysis
Risk factors
Social interactions
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Summary:Medicare's Merit-based Incentive Payment System (MIPS) includes episode-based cost measures that evaluate Medicare expenditures for specific conditions and procedures. These measures compare clinicians' cost performance and, along with other MIPS category scores, determine Medicare Part B clinician payment adjustments. The measures do not include risk adjustment for social risk factors. We found that adjusting for individual and community social risk did not have a meaningful impact on clinicians' cost measure performance. Across eight cost measures, 1.4 percent of clinician groups, on average, had an absolute change in their cost measure performance percentile of 10 percent or more (range, 0.4-3.4 percent). Prior analyses have generally found higher health care costs for patients with increased social risk. MIPS episode-based cost measures are distinct from previous cost measures because they only include costs related to the specific condition being evaluated. This unique approach may explain why costs were similar for patients with high and low social risk before any risk adjustment. MIPS episode-based cost measures do not appear to penalize clinicians who primarily care for patients with increased social risk.
ISSN:0278-2715
1544-5208
DOI:10.1377/hlthaff.2020.00440