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Gronbeck C, Feng PW, Feng H. Participation and Performance of Dermatologists in the 2017 Merit-Based Incentive Payment System. JAMA Dermatol. 2020;156(4):466–468. doi:10.1001/jamadermatol.2019.4860
Beginning in 2017, all dermatologists providing Medicare Part B services were required to participate in the Merit-Based Incentive Payment System (MIPS) or the Advanced Alternative Payment Model (AAPM).1 In MIPS, reporting of performance metrics determines a score that is used to determine a future fee adjustment. Although the Centers for Medicare & Medicaid Services (CMS) allowed physicians to avoid a negative adjustment in 2017 by submitting a single measure, future fee adjustments will be increasing and based on a score threshold. Amid the shift toward value-based care, it is important to understand MIPS participation and performance by dermatologists, including those who would benefit from resources to enhance engagement and performance.
Dermatologists were characterized by MIPS participation status and overall performance using data from the 2017 CMS Individual EC Public Reporting—Overall MIPS Performance data set.2 We linked dermatologists to additional CMS data sets, including the 2017 Physician Compare National File (demographics), Physician and Other Supplier National Provider Identifier Public Use File (billing), and Next Generation Accountable Care Organization Performance Results (AAPM affiliation). MIPS-eligible dermatologists included those who did not meet exemption criteria, including having less than 1 year of Medicare enrollment, belonging to an AAPM, or meeting a low-volume threshold. This study was deemed exempt from review by the institutional review board at the University of Connecticut Health Center owing to the use of existing, publicly available data.
Of the 9911 MIPS-eligible dermatologists, 8558 (86.4%) participated in MIPS. Among the 2991 dermatologists who did not participate, 1638 (54.7%) met at least 1 exemption criterion and 1353 (45.3%) elected not to participate. Among participants, 6314 (75.7%) would exceed the new 2019 threshold for a positive fee adjustment. Location in the Pacific region was more common than other regions (21.7% vs 10.3%-16.6% P < .001), as was multispecialty group or nonacademic hospital status (24.6% vs 10.0%-18.6%; P < .001) among elective nonparticipants. Payment-neutral participants had more years (SD) of practice experience (23.4 [13.8] vs 19.9 [12.2]; P < .001) and were part of individual practices as compared with other groups (4.8% vs 0.3%-1.9%; P < .001) (Table 1). Participants performing below the negative adjustment threshold had more years (SD) of practice experience (25.9 [12.6] vs 16.9 [11.0]; P < .001) and more frequently practiced individually vs in groups (54.3% vs 4.4%-21.6%; P < .001) (Table 2).
The MIPS participation rate among dermatologists demonstrated in this study exceeds that in the final year of the Physician Quality Reporting System (68.9%)3 yet remains below the all-specialty MIPS participation rate of 95%.1 This may be partially explained by delayed electronic health record adoption among dermatologists (80.0%), which was lower than any other specialty in 2017.4 Adoption delay has been particularly evident in the Pacific and Northeast regions, which demonstrated higher rates of MIPS avoidance in this analysis.5 It is also possible that dermatologists who do use electronic health records may lack proficiency with specific functions that influence MIPS performance, as evidenced by the markedly low Advancing Care Information scores among poorer MIPS performers.
The subgroup analysis linked increased practice experience and individual practice setting with limited degrees of MIPS participation. Financial and administrative burdens along with restricted outside partnerships may be inciting payment-neutral participation and lower scoring in this cohort. Importantly, reporting capability among solo practitioners may be bolstered in the future because CMS has allocated $20 million annually to alleviate these challenges, including through the establishment of virtual groups.6 Interestingly, hospital association alone did not guarantee MIPS involvement, despite the existence of sophisticated quality reporting systems in hospital settings.
This study has a few limitations. First, select dermatologists may not appear in the CMS data sets. Additionally, group size as defined in the National File data set may not always correlate with a dermatologist’s specific filing status. Importantly, this study is descriptive and cannot make conclusions regarding the relative importance of each characteristic or clinical outcome. Despite these shortcomings, this study address early successes and potential areas for improvement in MIPS engagement and value-based care performance among dermatologists.
Accepted for Publication: December 13, 2019.
Corresponding Author: Hao Feng, MD, MHS, Department of Dermatology, University of Connecticut Health Center, 21 South Rd, 2nd Floor, Farmington, CT 06032 (firstname.lastname@example.org).
Published Online: February 19, 2020. doi:10.1001/jamadermatol.2019.4860
Author Contributions: Mr Gronbeck had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Gronbeck, H. Feng.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Gronbeck, H. Feng.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Gronbeck, H. Feng.
Administrative, technical, or material support: P. Feng, H. Feng.
Study supervision: H. Feng.
Conflict of Interest Disclosures: Dr H. Feng reports serving as a consultant and medical monitor for Cytrellis Biosystems Inc. No other disclosures were reported.