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Invited Commentary
August 11, 2021

Primum Non Nocere—Avoiding Harm to Populations at Social Risk in the Design and Implementation of Value-Based Payment Programs

Author Affiliations
  • 1Vascular and Endovascular Surgery, University of Virginia, Charlottesville
  • 2Department of Surgery, University of California, Los Angeles, Los Angeles
  • 3Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio
JAMA Surg. 2021;156(11):1024-1025. doi:10.1001/jamasurg.2021.3747

The first paragraph of the statute establishing the Medicare program begins “Nothing in this subchapter shall be construed to authorize any Federal officer or employee to exercise any supervision or control over the practice of medicine or the manner in which medical services are provided….”1 This is a remarkable proposition, 46 years after the program’s initial passage, in a time during which reimbursement has become inextricably tied to the availability and quality of medical care. Byrd and Chung2 examined the association between patient socioeconomic status and surgeon performance in the first year of the Merit-Based Incentive Payment System (MIPS) program, a Medicare effort to shift toward value-based payment. Their results suggested that compared with surgeons caring for the patients at lowest social risk, surgeons caring for patients at the highest social risk were associated with the lowest final MIPS scores and a significantly increased risk of a negative payment adjustment.

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