Health System Clinicians Perform Better Under Medicare Value-Based Reimbursement

A study from researchers at Saint Louis University's College for Public Health and Social Justice published in the Journal of the American Medical Association found that doctors affiliated with health systems had better performance scores, fewer payment penalties, and more payment bonuses under the Medicare merit-based incentive payment system (MIPS) than unaffiliated clinicians, reports Healthcare Finance News . MIPS will increasingly link outpatient physicians' Medicare payments with their performance, and payment penalties and bonuses will account for 9 percent of total Medicare reimbursement by 2022. The management, administration, and technological infrastructure for reporting performance measures to the U.S. Centers for Medicare and Medicaid Services will be critical for maximizing success in MIPS. Analysis of 636,552 clinicians' performance determined that those affiliated with health systems saw mean performance scores of 79 versus 60 for unaffiliated clinicians on a scale of 0 to 100. Doctors affiliated with health systems were 99 percent less likely to be hit with payment penalties and 29 percent more likely to gain exceptional performance bonus payments than those not affiliated with health systems. The financial impact of MIPS is that system-affiliated clinicians will have more Medicare payment resources at the cost of unaffiliated clinicians.