key: cord-0074634-243ux17r
authors: Khullar, Dhruv; Bond, Amelia M.; O’Donnell, Eloise May; Qian, Yuting; Gans, David N.; Casalino, Lawrence P.
title: Time and Financial Costs for Physician Practices to Participate in the Medicare Merit-based Incentive Payment System: A Qualitative Study
date: 2021-05-14
journal: JAMA Health Forum
DOI: 10.1001/jamahealthforum.2021.0527
sha: 980b04c3309caf48c6453339cba3bfce689c70b1
doc_id: 74634
cord_uid: 243ux17r

IMPORTANCE: The Merit-based Incentive Payment System (MIPS) is a major Medicare value-based purchasing program, influencing payment for more than 1 million clinicians annually. There is a growing concern that MIPS increases administrative burden, and little is known about what it costs physician practices to participate in the program. OBJECTIVE: To examine the costs for independent physician practices to participate in MIPS in 2019. DESIGN, SETTING, AND PARTICIPANTS: This qualitative study identified and interviewed leaders of physician practices participating in the US Centers for Medicare & Medicaid Services (CMS) MIPS program, including those in MIPS alternative payment models. Time required and financial costs were calculated from responses to in-depth, semistructured interviews conducted from December 12, 2019, to June 23, 2020. Physician practices were categorized by size (small, 1-9 physicians; medium, 10-25; and large, ≥50), specialty (primary care, general surgery, or multispecialty), and US census region. Participants were asked about 2019 costs related to clinician and staff time, information technology, and external vendors. Time was converted to financial costs using the Medical Group Management Association’s Provider Compensation and the Management and Staff Compensation databases. MAIN OUTCOMES AND MEASURES: Annual time spent by staff on MIPS-related activities and mean per-physician costs to physician practices in 2019. RESULTS: Leaders of 30 physician practices (9 [30.0%] small primary care, 6 [20.0%] small general surgery, 4 [13.3%] medium primary care, 4 [13.3%] medium general surgery, and 7 [23.3%] large multispecialty) represented all US census regions, and 14 of the 30 (46.7%) practices participated in a MIPS alternative payment model in 2019. The mean per-physician cost to practices of participating in MIPS was $12 811 (interquartile range [IQR], $2861-$17 715). Physicians, clinical staff, and administrative staff together spent 201.7 (IQR, 50.9-295.2) hours annually per physician on MIPS-related activities. Medical assistants and nursing staff together spent a mean of 99.2 (IQR, 0-163.3) hours per physician each year; frontline physicians spent 53.6 (IQR, 0.6-55.8) hours; executive administrators spent 28.6 (IQR, 3.1-26.7) hours; other clinicians and staff spent a combined 20.3 (IQR, 0-36.8) hours. Physician time accounted for the greatest proportion of overall MIPS-related costs (54%; $6909; IQR, $94-$9905). CONCLUSIONS AND RELEVANCE: In this qualitative study, physician practice leaders reported significant time and financial costs of participating in the MIPS program. Attention to reducing the burden of MIPS may be warranted.

eMethods 1. Definitions of practice specialties eMethods 2. Calculation of maximum positive payment adjustment for average primary care physician in 2020 eDocument 1. Interview protocol eDocument 2. Invitation letter eTable 1. MIPS annual time (hours/year by position) per physician (median) eTable 2. MIPS costs domain per physician by category of staff (median) eTable 3. Practice attitude ranking eTable 4. Practices by US census region eTable 5. Total costs per physician of participating in the MIPS program eTable 6. Pair-wise comparisons evaluate for differences in the total practice costs per physician of participating in the MIPS program across practice types This supplemental material has been provided by the authors to give readers additional information about their work. 24. Is there anything that we haven't asked you about that you would like to add?

If you would like a copy of the articles we publish from these interviews, please let us know the best email to send them to.

We'd also like to get a sense of your general views on the MIPS program. I am asking if you will participate in a telephone interview to share your insights about MIPS and provide information on the financial costs of participating in MIPS. The identity of participants and all information collected in our study is strictly confidential and the study will not identify any specific individuals or practices.

Our findings will be submitted for publication in a peer-reviewed journal and will also be provided to the American Medical Association and the Physicians Foundation who are funding the research. Our team has published numerous articles in the New England Journal of Medicine, JAMA, and other medical and health policy journals.

Prior to the interview we will send you a list of questions we will ask. We recognize that your time is extremely valuable, so we are offering a $X honorarium for your participation.

If you are willing to participate, please respond to my message. I will then send additional information on the study and I will provide your contact information to our research team to schedule an interview.

If you have questions regarding the study, please contact me directly by email or you can phone me at MGMA, XXX-XXX-XXXX or XXXX@XXXX.com.

Thank you for your participation in this important study. Significance tests were performed using two-sample T-Test. All differences were not significant at the 5% significance level, except for the difference in the cost per physician between small general surgery practice and large multispecialty practice (P=0.013). a Small primary care indicates the P-values obtained from the comparisons for differences in the total practice costs per physician of participating in the MIPS between small primary care practices and each of the other practice types. b Medium primary care indicates the P-values obtained from the comparisons for differences in the total practice costs per physician of participating in the MIPS between medium primary care practices and each of the other practice types. c Small general surgery indicates the P-values obtained from the comparisons for differences in the total practice costs per physician of participating in the MIPS between small general surgery practices and each of the other practice types. d Medium general surgery indicates the P-values obtained from the comparisons for differences in the total practice costs per physician of participating in the MIPS between medium general surgery practices and each of the other practice types. e Large multispecialty indicates the P-values obtained from the comparisons for differences in the total practice costs per physician of participating in the MIPS between large multispecialty practices and each of the other practice types. f MIPS APM indicates the P-values obtained from the comparisons for differences in the total practice costs per physician of participating in the MIPS between APM practices and Non-APM practices.

APM Status APM $15,410 $8,025 $6

Medium Primary Care $13,631 $11

Large Multispecialty $4,107 $1,690 $1

Abbreviations: MIPS, Merit-Based Incentive Payment System

Alternative Payment Model. a Costs per physician indicates per physician cost to practices of participating in the MIPS program in 2019. The cost includes staff expenses, IT costs, and external vendor costs specifically for MIPS. Additional details on the cost definition and calculation methods can be found in the manuscript Analysis section