Does MIPS reporting improve quality?

Health care professionals are divided over the current Merit-Based Incentive Payment System (MIPS) program that determines Medicare payment adjustments based on provider care. Some think the system is valuable because they believe it keeps the focus on improving care, while others believe that MIPS only teaches health care professionals the art of clicking buttons.

How MIPS reporting processes influence quality of clinical care was the topic of a pro-con debate yesterday, where attendees heard from anesthesiologists on both sides of the issue.

Richard P. Dutton , M.D., M.B.A., FASA, Chief Quality Officer for U.S. Anesthesia Partners (USAP) and Adjunct Professor at Texas A&M University School of Medicine, presented in support of MIPS. On the opposite side was T.J. Gan, M.D., M.B.A., FRCA, MHS, Professor and Chairman in the Department of Anesthesiology at Stony Brook Medicine in New York.

Richard P. Dutton , M.D., M.B.A, FASA

The argument for MIPS

The primary reason health care professionals should support MIPS is that it improves quality, according to Dr. Dutton. He cited three essential benefits:

  • Economics of MIPS
  • Collateral benefits of data collection
  • Direct improvement of patient outcomes

Dr. Dutton used USAP as his economic example. If USAP ignored MIPS, the penalty for doing so would be $20 million. By contrast, USAP’s incentive for doing MIPS well equals $4 million. However, its cost for MIPS data collection and reporting is $5.6 million. Even though USAP is spending more than it receives in incentives, Dr. Dutton pointed out that it’s still saving millions in penalties.

“MIPS reporting on a purely financial basis is motivated by avoidance of penalties rather than winning incentives,” Dr. Dutton said. “It’s not about the incentives. Most anesthesiologists do the minimum involved to avoid the penalty,” Dr. Dutton said. “And we can take that money and also do something good.”

The collateral benefits of doing the data collection that MIPS requires are many, Dr. Dutton said. You can be a good citizen of your hospital and share the data, which can help the facility win and keep contracts. Sharing the data can also help the hospital achieve a higher quality rating, increasing its payment from Medicare.

“I get to use it in lots of different ways because (by collecting data for MIPS) I get a warehouse of data I can use however I want,” Dr. Dutton said.

Another way he likes to use this data is by sharing it with academic partners to help drive science and further research.

Dr. Dutton argued that MIPS reporting has a direct improvement on patient outcomes and quality of care. He used the Hawthorne Effect as a supporting argument. It states that the act of measuring something is going to improve it, that there is an alteration of behavior.

“What you measure shows your priority as a business,” Dr. Dutton said. “Your measurement system provides a daily reminder of the important activities. This drives change.”

T. J. Gan, M.D., M.B.A., FRCA, MHS

The argument against MIPS

MIPS reporting does not improve quality care, is too costly and the parameters for qualifying for MIPS incentives are unrealistic, according to Dr. Gan, who argued against MIPS during the debate.

He pointed out that the U.S. spends $3.4 trillion on health care each year, yet has a life expectancy rate that falls well below the median. “When you spend that much, you expect value,” he said.

The explicit goal of MIPS, he explained, is to link health care quality and payment together so that patients experience better health outcomes.

Dr. Gan said there is a difference between process measures and outcome measures. MIPS, he believes, measures process. Maintaining quality is more about patient interaction and less about reporting about it, he said.

Therefore, the system that is supposed to improve quality (MIPS) is actually working against itself because it requires health care professionals to spend more time reporting, which results in less time with their patients.

Instead, health care professionals should be more focused on Inpatient Quality Indicators, which reflect quality of care inside hospitals and include inpatient mortality and readmission, and Patient Safety Indicators, which focus on potentially preventable instances of complications and other iatrogenic events resulting from exposure to the health care system.

“We spend an enormous amount of financial and human resource to meet MIPS, introduced by CMS,” Dr. Gan said. “However, the intended outcomes of improving care are far from certain. Numerous studies have demonstrated that implementing MIPS has resulted in doctors spending less time with direct patient care, focusing on EMR and checking boxes instead of direct interactions with patients, leading to burnout and low morale among health care workers.”

To qualify for a MIPS incentive, to even reach “average” incentive level, you have to reach the 92% mark, which Dr. Gan described as demotivating. This, combined with the statistic that U.S. physician practices spend more than $15.4 billion annually to report quality measures, has many small practices feeling so overwhelmed by the idea of complying with MIPS that they were interested in selling their practices.

“I don’t want to leave on a negative note,” said Gan. “There are ways to improve patient outcomes. Focusing on reduced length of stay in the hospital not only improves outcomes, but also saves money.

“This is where we should be focusing our effort,” he said. “Not on checking boxes.”

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