Orthopaedic surgeons participating in the Merit-based Incentive Payment System (MIPS) demonstrate robust performance, with the vast majority securing positive payment adjustments. This holds true even as many surgeons care for a significant number of socially at-risk patients, shedding light on the effectiveness of recent policy adjustments aimed at supporting complex medical practices.
Performance Metrics Under MIPS
In the latest evaluation, 97% of orthopaedic surgeons received positive payment adjustments through MIPS, while only a minimal fraction faced penalties. Surgeons were categorized based on the proportion of patients eligible for both Medicare and Medicaid, serving as an indicator of social risk. Notably, those managing a higher percentage of socially at-risk patients achieved superior MIPS scores compared to their counterparts with fewer at-risk patients.
Impact of the Complex Patient Bonus
The introduction of the Complex Patient Bonus (CPB) appears to play a significant role in enhancing MIPS scores for surgeons treating more socially at-risk populations. Statistical analysis revealed that the presence of CPB correlates with higher performance scores, highlighting its effectiveness in mitigating potential financial disadvantages associated with serving complex patient demographics.
• Surgeons with higher social risk patient loads benefit from the Complex Patient Bonus.
• The majority consistently receive positive financial adjustments, indicating broad MIPS success.
• Minimal penalties suggest effective risk adjustment mechanisms in place.
• No significant difference in payment adjustments between high and low-risk groups.
The study analyzed data from 9,707 orthopaedic surgeons in 2021, revealing that those in the highest quintile for social risk achieved higher MIPS scores with the CPB compared to those in the lowest quintile. However, payment adjustments remained uniform across different risk groups, emphasizing the neutral financial impact despite varying patient demographics.
Orthopaedic surgeons are navigating a landscape where quality performance under MIPS does not necessarily translate to varied financial outcomes based on patient social risk. The findings underscore the importance of comprehensive risk-adjustment strategies to ensure that performance metrics accurately reflect the complexities of patient care without unintended financial repercussions.
Effective risk adjustment remains pivotal as value-based payment models evolve. Orthopaedic surgeons can leverage these insights to better understand their performance metrics, advocate for nuanced policy adjustments, and engage in quality improvement initiatives that align with patient-centered care. Future research should focus on refining performance measures to capture the true quality of surgical care, ensuring that payment systems incentivize excellence without bias against serving vulnerable populations.
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