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UPJ INSIGHT Urologist Merit-Based Incentive Payment System Performance and Quality of Prostate Cancer Care
By: Avinash Maganty, MD, MS, University of Michigan, Ann Arbor; Samuel R. Kaufman, MA, University of Michigan, Ann Arbor; Mary K. Oerline, MS, University of Michigan, Ann Arbor; Kassem Faraj, MD, MS, University of Michigan, Ann Arbor; Megan E. V. Caram, MD, MS, University of Michigan, Ann Arbor, VA Ann Arbor Healthcare System, Michigan; Vahakn B. Shahinian, MD, MS, University of Michigan, Ann Arbor; Brent K. Hollenbeck, MD, MS, Massachusetts General Hospital, Boston | Posted on: 19 Jan 2024
Maganty A, Kaufman SR, Oerline MK, et al. Association between urologist Merit-Based Incentive Payment System performance and quality of prostate cancer care. Urol Pract. 2024;11(1):207-214.
Study Need and Importance
The intent of the Merit-Based Incentive Payment System (MIPS) is to promote both high-quality and efficient care. However, several features of the program may limit its ability to capture quality, particularly for physicians managing specialty conditions. Consequently, it is unclear if MIPS performance is indicative of better quality. Therefore, this study sought to assess the relationship between urologist MIPS performance, quality, and spending for men with newly diagnosed prostate cancer.
What We Found
The association between MIPS performance and quality prostate cancer care was modest at best. Better MIPS performance was associated with a higher rate of confirmatory testing in men initiating active surveillance for prostate cancer (Figure). However, MIPS performance was not associated with other dimensions of quality, nor spending.
Limitations
The findings from this study must be considered in the context of several limitations. First, the quality measures evaluated are not comprehensive, nor do they capture all important domains to men with prostate cancer. Second, there is potential for unmeasured confounding that may influence adherence to quality measures. Third, we are unable to adjust for disease severity as this is not available in administrative claims data.
Interpretation for Patient Care
Performance in MIPS may not correspond to quality of prostate cancer care, a common and expensive condition managed by urologists. Although this study focused on a limited set of quality measures for a single condition, it is illustrative of the broader concerns of the MIPS program—it may not capture quality and thus fails to incentivize better care delivery. Furthermore, the program imposes significant time and financial burden on physicians, for potentially little benefit for patients. As physician reimbursement continues to shift towards value-based payment, condition-specific models may provide an avenue to better align incentives with quality that is meaningful to patients.
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