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Original Investigation
May 21, 2020

Otolaryngologist Performance in the Merit-Based Incentive Payment System in 2017

Author Affiliations
  • 1Department of Otolaryngology, Massachusetts Eye and Ear, Boston
  • 2Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
  • 3Harvard Business School, Boston, Massachusetts
  • 4Mass General Brigham, Boston, Massachusetts
  • 5Warren Alpert Medical School of Brown University, Providence, Rhode Island
  • 6St Elizabeth’s Medical Center, Department of Surgery, Tufts University School of Medicine, Boston, Massachusetts
  • 7Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
  • 8Patient-Reported Outcomes, Value and Experience (PROVE) Center, Brigham and Women’s Hospital, Boston, Massachusetts
  • 9Division of Otolaryngology–Head and Neck Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
JAMA Otolaryngol Head Neck Surg. Published online May 21, 2020. doi:10.1001/jamaoto.2020.0847
Key Points

Question  How did otolaryngologists perform in the Merit-Based Incentive Payment System (MIPS) for Medicare in 2017?

Findings  This cross-sectional study found that in 2017, the Centers for Medicare & Medicaid Services required 6512 active otolaryngologists to participate in the MIPS; among these, 68.6% received bonuses for exceptional performance and 10.3% incurred penalties for failure to participate. The proportion of otolaryngologists earning bonuses for exceptional performance varied by reporting affiliation (individual: 56.5%; group: 67.6%; alternative payment model: 97.1%).

Meaning  Most otolaryngologists participating in the 2017 MIPS received performance bonuses, although variation exists within the field.

Abstract

Importance  The Merit-Based Incentive Payment System (MIPS) for Medicare is the largest pay-for-performance program in the history of health care. Although the Centers for Medicare & Medicaid Services (CMS) launched the MIPS in 2017, the participation and performance of otolaryngologists in this program remain unclear.

Objective  To characterize otolaryngologist participation and performance in the MIPS in 2017.

Design, Setting, and Participants  Retrospective cross-sectional analysis of otolaryngologist participation and performance in the MIPS from January 1 through December 31, 2017, using the publicly available CMS Physician Compare 2017 eligible clinician public reporting database.

Main Outcomes and Measures  The number and proportion of active otolaryngologists who participated in the MIPS in 2017 were determined. Overall 2017 MIPS payment adjustments received by participants were determined and stratified by reporting affiliation (individual, group, or alternative payment model [APM]). Payment adjustments were categorized based on overall MIPS performance scores in accordance with CMS methodology: penalty (<3 points), no payment adjustment (3 points), positive adjustment (between 3 and 70 points), or bonus for exceptional performance (≥70 points).

Results  In 2017, CMS required 6512 of 9526 (68.4%) of active otolaryngologists to participate in the MIPS. Among these otolaryngologists, 5840 (89.7%) participated; 672 (10.3%) abstained and thus incurred penalties (−4% payment adjustment). The 6512 participating otolaryngologists reported MIPS data as individuals (1990 [30.6%]), as groups (3033 [46.6%]), and through CMS-designated APMs (964 [14.8%]). The majority (4470 of 5840 [76.5%]) received bonuses (maximum payment adjustment, +1.9%) for exceptional performance, while a minority received only a positive payment adjustment (1006 of 5840 [17.2%]) or did not receive an adjustment (364 of 5840 [6.2%]). Whereas nearly all otolaryngologists reporting data via APMs (936 of 964 [97.1%]) earned bonuses for exceptional performance, fewer than 70% of otolaryngologists reporting data as individuals (1124 of 1990 [56.5%]) or groups (2050 of 3033 [67.6%]) earned such bonuses. Of note, nearly all otolaryngologists incurring penalties (658 of 672 [97.9%]) were affiliated with groups.

Conclusions and Relevance  Most otolaryngologists participating in the 2017 MIPS received performance bonuses, although variation exists within the field. As CMS continues to reform the MIPS and raise performance thresholds, otolaryngologists should consider adopting measures to succeed in the era of value-based care.

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