Plastic Surgeons and Equity: Are Merit-based Incentive Payment System (MIPS) Scores Impacted by Minority Patient Caseload?
Jacqueline N. Byrd, MD, MPH, Kevin C. Chung, MD, MS.
University of Michigan, Ann Arbor, MI, USA.
PURPOSE: The Centers for Medicare and Medicaid Services introduced the Merit-Based Incentive Payment System (MIPS) in 2017 to incentivize quality for all outpatient physicians. We hypothesized that the MIPS scores for plastic surgeons is impacted by the existing measures of patient disadvantage, the minority patient caseload and dual eligibility.
METHODS: We conducted a retrospective cohort study of plastic surgeons participating in Medicare and MIPS using the Physicians Compare National Downloadable File and MIPS scores. Minority patient caseload was determined per Medicare's classifications. We evaluated the characteristics of participating surgeons, their patient caseloads and their scores.
RESULTS: Of 4,539 plastic surgeons participating in Medicare, 1,257 participated in MIPS in the first year of scoring. The mean MIPS score was 53.2 (SD 42.2), which is 20 points lower than the mean score of general surgeons reported in our prior work. The average patient caseload is 85% White, with racial/ethnicity data available for 73% of participating surgeons. In multivariable regression, higher non-White patient caseload is associated with a lower MIPS score (p=0.04).
CONCLUSION: The negative payment adjustments determined by MIPS scores threaten access to reconstructive care for vulnerable patients. CMS must consider plastic surgery-specific quality measures as well as patient caseload data to ensure equitable surgeon scoring.
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