Factors Influencing Radiologist Performance in the Merit-Based Incentive Payment System.

Abstract

The Merit-Based Incentive Payment System (MIPS) is the largest pay-for-performance program that links reimbursement to performance of Medicare clinicians. This study evaluated radiologist performance in the 2019 MIPS program and predictors of scores and underperformance. Data were primarily from the CMS 2019 Quality Payment Program Experience Report. Multivariable linear and logistic regressions were conducted to identify factors associated with MIPS overall scores and with not reaching exceptional performance bonus status, respectively. An exploratory analysis of top 10 reported quality measures was performed. Among 22,875 radiology participants, 74.8% participated in group reporting, 4.3% as an individual and 20.9% through MIPS Advanced Payment Model (APM). The mean final score was 88.8, with 88.3% reaching exceptional status. Participation in a MIPS APM was associated with a 7.2-point (95% confidence interval [CI], 6.97-7.40) higher score compared with group reporting, and individual reporting was associated with a 28.3-point (95% CI, -30.12 to -26.54) lower score. Radiologists in practices of more than 500 clinicians had a 10.3-point (95% CI, 9.06-11.03) higher final score compared with those in practices of 10 or fewer clinicians. Similarly, radiologists participating as individuals or via smaller practices were less likely to achieve exceptional performance. The top 10 quality measures for group and individual reporting radiologists were all radiology related, whereas MIPS APM radiologists did not report any radiology-related measures. Most radiologists performed successfully in 2019 MIPS, but success varied across numerous factors. Reporting type and practice size were most predictive of program performance. The results reveal potential biases that should be addressed in the MIPS program.