P4068 - Gastroenterologists Performance and Payments in the Merit-Based Incentive Payment System

Xiaohan Ying, MD¹, Nicole Palmer, BA, MPH², Felipe Camelo, BS², Emily Smith, MD², Sri Tummalapalli, MD, MBA², Rhea Fogla, MD¹, Arun Jesudian, MD^2
1New York-Presbyterian/Weill Cornell, New York, NY; ²Weill Cornell Medicine, New York, NY

Introduction: The Merit-Based Incentive Payment System (MIPS) is a mandatory pay-for-performance program created by the Centers for Medicare & Medicaid Services, which enrolls over 300,000 physicians. Participating clinicians are assigned a final score (FS) based on four categories, which is used to determine financial incentives/penalties (payment adjustment (PA): -7% to + 1.79%). Gastroenterologists’ performance in the MIPS program has not been reported.

Methods: MIPS data was obtained from 2019 Quality Payment Program Experience. Clinicians can report to MIPS as Individual, part of a group, or part of an alternative payment model (APM) (e.g. Medicare Shared Savings Program). Univariate was performed with t-test and Pearson, multivariate was performed with multiple regression analysis.

Results: Of 12,872 gastroenterologists who participated in MIPS in 2019, 1,724 (13.4%) were practicing as individuals, 6,150 (47.8%) were part of a group, and 4,998 (38.8%) were part of an APM. The average FS for gastroenterologist was 85.4 (IQR 82.8-95.9), compared to that of all physicians (80.5, IQR 67.4-93.7). The average years in practice was 11 (IQR 9-14), and is negatively associated with FS (p< 0.01) and PA (p< 0.01). Individuals had lower FS (66.0) compared to those in a group (83.1, p< 0.01) and those in an APM (94.9, p< 0.01). Similarly, individuals had lower PA (0.6%) compared to those in a group (0.8%, p< 0.001) and those in a APM (1.5%, p< 0.01). Practice size is positively associated with FS (p< 0.01) and PA (p< 0.01). However, there is no statistical difference in practicing in a rural (FS 84.6; PA 1.0%) vs nonrural setting (FS 85.5, p=0.09; PA 1.0%, p=0.52). In terms of multivariable analysis, participation type (p< 0.001) and practice size (p< 0.001) remained statistically significant for both FS and PA; however, year in medicine did not remain statistically significant (FS: p=0.32, PA: p=0.55).

Discussion: Gastroenterologists have a higher FS compared to all physician participants in the MIPS program. Participation in APM and being a part of a larger practice are associated with higher FS and PA. MIPS was developed as a pay-for-performance program to continue to drive high-quality, high-value care in the US. However, there are concerns about its ability to assess quality given the more developed infrastructure for data processing and reporting in larger practices. Further studies are needed to improve MIPS to reflect best clinical practices rather than processing and reporting processes.


Disclosures:


Xiaohan Ying, MD¹, Nicole Palmer, BA, MPH², Felipe Camelo, BS², Emily Smith, MD², Sri Tummalapalli, MD, MBA², Rhea Fogla, MD¹, Arun Jesudian, MD². P4068 - Gastroenterologists Performance and Payments in the Merit-Based Incentive Payment System, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.