MIPS Study: Health System Clinicians Outperforming Independent Clinicians

The Merit-based Incentive Payment System may give a payment edge to health system-affiliated outpatient clinicians compared to independent clinicians.

Clinicians affiliated with health systems have posted significantly better performance ratings in the Merit-based Incentive Payment System (MIPS) compared to independent clinicians, recent research found.

Most clinicians participate in MIPS, which is a value-based payment system created by the Centers for Medicare & Medicaid Services (CMS). The first payment year for MIPS was 2019, with payment based on 2017 performance. Last year, clinicians participating in MIPS received payment bonuses or penalties as high as 4% of Medicare reimbursement based on performance scores for quality and cost metrics.

The recent research, which was published by the Journal of the American Medical Association, features data collected from more than 630,000 clinicians working at outpatient clinics across the country. Nearly half of the clinicians were affiliated with a health system.

The study features several key data points:

• The mean final MIPS performance score for clinicians affiliated with health systems was 79.0 vs. 60.3 for independent clinicians. The final MIPS performance score ranges from 0 to 100, with higher scores indicating better performance.
   
• The percentage of clinicians who received a penalty payment adjustment was 2.8% for clinicians affiliated with a health system vs. 13.7% for independent clinicians.
   
• The percentage of clinicians who received a positive payment adjustment was 97.1 for clinicians affiliated with a health system vs. 82.6% for independent clinicians.
   
• The percentage of clinicians who received a bonus payment adjustment was 73.9% for clinicians affiliated with a health system vs. 55.1% for independent clinicians.

"For clinicians participating in the 2019 MIPS, health system affiliation was associated with substantially better performance scores. Health system affiliation was also associated with more favorable value-based reimbursement," the study's co-authors wrote.

Interpreting the data

The study speculates the technological advantages that health systems hold over most independent physician practices may account for the better MIPS performance by clinicians affiliated with health systems.

"Clinicians who were affiliated with health systems had higher rates of reporting and performance on technology-dependent measures, such as providing patients access to their health records or electronic prescribing compared with their unaffiliated peers," the study's co-authors wrote.

In addition, two MIPS performance measurement domains are dependent on technology—meaningful use of electronic health records and practice process improvement activities. "Thus, health system affiliation may provide needed technology and management infrastructure that helps clinicians succeed across a range of metrics under value-based payment," the study's co-authors wrote.

Beyond a technological advantage, health systems may generate other MIPS benefits for their clinicians compared to independent clinicians, according to the study.

"Integration in the healthcare delivery system is associated with higher screening rates, better quality on process of care measures for chronic conditions such as diabetes, improved meaningful use of electronic health records, and more use of care management. In addition, practices affiliated with health systems may have more resources to support the measurement, selection, and reporting of quality measures to the CMS."

The study did not reach a conclusion on whether clinicians affiliated with health systems provide a higher level of quality care to patients compared to independent clinicians.