Psychiatrists score lower than other physicians on Medicare’s Merit-Based Incentive Payment System (MIPS) and are more likely to incur negative payment adjustments than other physicians who participate in the system, a study published today in JAMA Health Forum has found. The findings suggest more research is needed to evaluate the appropriateness of MIPS measures for psychiatrists.
MIPS—a mandatory, outpatient value-based payment program that ties reimbursement to performance on cost and quality measures—was “designed to assess performance for a broad range of outpatient clinicians, although different clinicians practice in widely disparate settings and elect to report different quality measures,” wrote Andrew C. Qi, M.D., of Washington University School of Medicine in St. Louis and colleagues. “Psychiatrists represent one group for whom MIPS may be particularly poorly suited to adequately assess care quality.”
The researchers analyzed data from 9,356 psychiatrists and 196,306 other outpatient physicians who participated in the 2020 MIPS, which covered performance in 2018. The mean final MIPS performance score for psychiatrists was 84.0 compared with 89.7 for other physicians. Furthermore, 6.1% of psychiatrists received a penalty compared with 2.9% of other physicians, 92.6% of psychiatrists received a positive payment adjustment compared with 96.3% of other physicians, and 82.0% of psychiatrists received a bonus payment adjustment compared with 88.7% of other physicians.
MIPS adjusts Medicare Part B payments based on performance in four performance categories: quality, cost, promoting interoperability, and improvement activities. Most of the performance disparities were driven by lower scores in the quality and interoperability domains. For example, psychiatrists performed more poorly on measures such as participation in health information exchanges; documentation of patient medications in medical records; and preventive measures that are not related to psychiatry, such as cancer screening. Regarding the measures that appear most relevant to the practice of psychiatry, psychiatrists had higher reporting rates and better performance, including for depression screening and follow-up, and screening for future fall risk, the authors noted.
“Ideally, each specialty would be judged on measures of greatest relevance to the patients treated by that specialty,” Qi and colleagues wrote. “The fact that just as many psychiatrists in our exploratory analysis reported on quality measures for cancer screening and flu shots as for depression care suggests that MIPS performance reflects multispecialty group performance as opposed to quality of psychiatric care.” They added that most measures included in the mental/behavioral health specialty set were almost entirely unreported, which points to a need to develop and encourage the use of measures relevant to psychiatric care in MIPS.
“The increased administrative and financial burdens introduced by MIPS may further disincentivize psychiatrists from treating Medicare patients, resulting in an even greater number of psychiatrists who require patients to pay out of pocket for services,” they wrote. “This factor has concerning implications for access to mental health care for Medicare beneficiaries.”
They concluded, “[Medicare] may want to reconsider the use of many current MIPS measures for assessing the performance of psychiatrists,” the researchers concluded.
For related information, see the Psychiatric News article “PsychPRO Reaping Benefits for Clinicians Reporting MIPS Data.”
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