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Does the Merit-Based Incentive Payment System Disproportionately Affect Safety-Net Practices?

  • 1Department of Medicine, University of Washington, Seattle
  • 2Value & Systems Science Lab, Seattle, Washington
  • 3Leonard Davis Institute of Health Economics, Wharton School, University of Pennsylvania, Philadelphia
  • 4Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
  • 5Michael J Crescenz VA Medical Center, Philadelphia, Pennsylvania

Three years since the introduction of the nationwide Merit-Based Incentive Payment System (MIPS), the US Centers for Medicare & Medicaid Services (CMS) continues using the program to incentivize clinicians to improve health care value for Medicare beneficiaries. The MIPS is a pay-for-performance program that increases payment rates for clinicians who provide high-value care, while penalizing clinicians who do not by decreasing their payment rates. The program’s design has been largely similar since launching in 2017. As in earlier years, participating clinicians are evaluated on performance in the domains of (1) quality (as assessed through clinical quality measures), (2) improvement activities (initiatives that can improve care), (3) costs (patients’ resource use and spending), and (4) promotion of interoperability (use of health information technology to improve care delivery). Performance in each domain is incorporated into an overall composite performance score that ultimately dictates whether clinicians receive upward, downward, or no payment rate adjustments.

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