Health system clinicians perform better under medicare value-based reimbursement

September 08, 2020

ST. LOUIS - A team of researchers led by Kenton Johnston, Ph.D., an associate professor of health management and policy at Saint Louis University's College for Public Health and Social Justice, conducted a study investigating the association between health system affiliations of clinicians and their performance scores and payments under Medicare value-based reimbursement.

Their findings, "Association of Clinician Health System Affiliation with Outpatient Performance Ratings in the Medicare Merit-based Incentive Payment System," were published online Sept. 8 in the Journal of the American Medical Association.

The researchers found that clinicians who were affiliated with health systems had better performance scores and received fewer payment penalties and more payment bonuses under the Medicare Merit-based Incentive Payment System (MIPS) than clinicians not affiliated with health systems.

"Physicians need to take the MIPS seriously. More and more of outpatient physicians' payments from Medicare will be tied to their performance under the MIPS," Johnston said. "Payment penalties and bonuses will hit 9 percent of physicians' total Medicare reimbursement by 2022. There are things physician practices can do to maximize their success on the MIPS. But this requires the management, administration and technological infrastructure to report performance measures to the Centers for Medicare and Medicaid Services."

The study used 2019 MIPS data to examine 636,552 clinicians' performance and found that clinicians affiliated with health systems achieved mean performance scores of 79 versus 60 for unaffiliated clinicians, on a scale of 0 to 100. Physicians affiliated with health systems were 99 percent less likely to receive payment penalties and 29 percent more likely to receive exceptional performance bonus payments than physicians not affiliated with health systems.

Clinicians who affiliate with health systems appear to do substantially better under Medicare value-based payment. However, clinicians could self-select the performance measures they were evaluated on, so it is unclear whether findings represent real differences in patient quality of care or other factors. That is an area for future research.

Because the MIPS is a zero-sum game, Johnston said, the financial consequences are that system-affiliated clinicians are recipients of greater Medicare payment resources at the expense of clinicians not affiliated with health systems.

This is likely to amplify the existing trend toward clinician consolidation within health systems as clinicians seek sophisticated analytics, informatics, and administrative help to maximize performance and reimbursement under value-based payment programs.

MIPS, which is authorized under the Medicare Access and CHIP Reauthorization Act, is a mandatory pay-for-performance program for clinicians participating in Medicare in the outpatient setting. Clinician performance under MIPS looks at quality of care, meaningful use of electronic health records, improvement activities for patient care processes and cost.
Co-authors include Timothy L. Wiemken, Ph.D. of the Department of Health and Clinical Outcomes Research at Saint Louis University; Jason M. Hockenberry, Ph.D. of the Department of Health Policy and Management at the Rollins School of Public Health at Emory University; Jose F. Figueroa, M.D., of the Department of Health Policy and Management at the T.H. Chan School of Public Health at Harvard University; and Karen E. Joynt Maddox, M.D., Co-Director of the Center for Health Economics and Policy at Washington University in St. Louis.

The study relied on publicly-reported clinician and health system data released by the Centers for Medicare and Medicaid Services and the Agency for Healthcare Research and Quality.

College for Public Health and Social Justice

The Saint Louis University College for Public Health and Social Justice is the only academic unit of its kind, studying social, environmental and physical influences that together determine the health and well-being of people and communities. It also is the only accredited school or college of public health among nearly 250 Catholic institutions of higher education in the United States.

Guided by a mission of social justice and focus on finding innovative and collaborative solutions for complex health problems, the College offers nationally recognized programs in public health, social work, health administration, applied behavior analysis, and criminology and criminal justice.

Saint Louis University

Related Public Health Articles from Brightsurf:

COVID-19 and the decolonization of Indigenous public health
Indigenous self-determination, leadership and knowledge have helped protect Indigenous communities in Canada during the coronavirus disease 2019 (COVID-19) pandemic, and these principles should be incorporated into public health in future, argue the authors of a commentary in CMAJ (Canadian Medical Association Journal)

Public health consequences of policing homelessness
In a new study examining homelessness, researchers find that policy such a lifestyle has massive public health implications, making sleeping on the street even MORE unhealthy.

Electronic health information exchange improves public health disease reporting
Disease tracking is an important area of focus for health departments in the midst of the COVID-19 pandemic.

Pandemic likely to cause long-term health problems, Yale School of Public Health finds
The coronavirus pandemic's life-altering effects are likely to result in lasting physical and mental health consequences for many people--particularly those from vulnerable populations--a new study led by the Yale School of Public Health finds.

The Lancet Public Health: US modelling study estimates impact of school closures for COVID-19 on US health-care workforce and associated mortality
US policymakers considering physical distancing measures to slow the spread of COVID-19 face a difficult trade-off between closing schools to reduce transmission and new cases, and potential health-care worker absenteeism due to additional childcare needs that could ultimately increase mortality from COVID-19, according to new modelling research published in The Lancet Public Health journal.

The Lancet Public Health: Access to identification documents reflecting gender identity may improve trans mental health
Results from a survey of over 20,000 American trans adults suggest that having access to identification documents which reflect their identified gender helps to improve their mental health and may reduce suicidal thoughts, according to a study published in The Lancet Public Health journal.

The Lancet Public Health: Study estimates mental health impact of welfare reform, Universal Credit, in Great Britain
The 2013 Universal Credit welfare reform appears to have led to an increase in the prevalence of psychological distress among unemployed recipients, according to a nationally representative study following more than 52,000 working-age individuals from England, Wales, and Scotland over nine years between 2009-2018, published as part of an issue of The Lancet Public Health journal on income and health.

BU researchers: Pornography is not a 'public health crisis'
Researchers from the Boston University School of Public Health (BUSPH) have written an editorial in the American Journal of Public Health special February issue arguing against the claim that pornography is a public health crisis, and explaining why such a claim actually endangers the health of the public.

The Lancet Public Health: Ageism linked to poorer health in older people in England
Ageism may be linked with poorer health in older people in England, according to an observational study of over 7,500 people aged over 50 published in The Lancet Public Health journal.

Study: Public transportation use linked to better public health
Promoting robust public transportation systems may come with a bonus for public health -- lower obesity rates.

Read More: Public Health News and Public Health Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to