With the Merit-Based Incentive Payment System, Pay for Performance Is Now National Policy
Authors: Teryl K. Nuckols
Journal: Annals of Internal Medicine (2017)

Editorials7 March 2017With the Merit-Based Incentive Payment System, Pay for Performance Is Now National PolicyTeryl K. Nuckols, MD, MSHSTeryl K. Nuckols, MD, MSHSFrom Cedars-Sinai Medical Center, Los Angeles, California.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M16-2947 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Effective 1 January 2017, 600 000 clinicians who care for adults with fee-for-service (Part B) Medicare insurance are subject to the mandatory Quality Payment Program's financial incentives for high-quality, high-value care. This complex policy was established under the Medicare Access and CHIP Reauthorization Act of 2015, which passed with strong bipartisan support. Clinicians can participate in the Quality Payment Program through the Merit-Based Incentive Payment System (MIPS)—the default track—or through Advanced Alternative Payment Models, such as risk-bearing accountable care organizations. Under MIPS, the Centers for Medicare & Medicaid Services (CMS) will assign penalties or rewards to 500 000 clinicians in all specialties, ...References1. Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive Under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models, 42 C.F.R. § 414 and 495 (2016). Google Scholar2. Mendelson A, Kondo K, Damberg C, Low A, Motúapuaka M, Freeman M, et al. The effects of pay-for-performance programs on health, health care use, and processes of care. A systematic review. Ann Intern Med. 2017;166:341-53. doi:10.7326/M16-1881 LinkGoogle Scholar3. Eijkenaar F, Emmert M, Scheppach M, Schöffski O. Effects of pay for performance in health care: a systematic review of systematic reviews. Health Policy. 2013;110:115-30. [PMID: 23380190] doi:10.1016/j.healthpol.2013.01.008 CrossrefMedlineGoogle Scholar4. Damberg CL, Sorbero ME, Lovejoy SL, Martsolf GR, Raaen L, Mandel D. Measuring success in health care value-based purchasing programs: findings from an environmental scan, literature review, and expert panel discussions. Santa Monica, CA: RAND Corporation; 2014. Accessed at www.rand.org/pubs/research_reports/RR306.html on 16 December 2016. Google Scholar5. Kondo K, Damberg C, Mendelson A, Motu'apuaka M, Freeman M, O'Neil M, et al. Understanding the Intervention and Implementation Factors Associated with Benefits and Harms of Pay for Performance Programs in Healthcare. Washington, DC: U.S. Department of Veterans Affairs; 2015. Google Scholar6. National Committee for Quality Assurance. HEDIS Measures. Washington, DC: National Committee for Quality Assurance. Accessed at www.ncqa.org/hedis-quality-measurement/hedis-measures on 18 December 2016. Google Scholar7. Frankel BA, Bishop TF. A cross-sectional assessment of the quality of physician quality reporting system measures. J Gen Intern Med. 2016;31:840-5. [PMID: 27197975] doi:10.1007/s11606-016-3693-3 CrossrefMedlineGoogle Scholar8. Centers for Medicare & Medicaid Services. CMS Quality Measure Development Plan: Supporting the Transition to the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). Baltimore: Centers for Medicare & Medicaid Services; 2016. Accessed at www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-MIPS-and-APMs.html on 18 December 2016. Google Scholar9. Emanuel EJ, Ubel PA, Kessler JB, Meyer G, Muller RW, Navathe AS, et al. Using behavioral economics to design physician incentives that deliver high-value care. Ann Intern Med. 2016;164:114-9. [PMID: 26595370]. doi:10.7326/M15-1330 LinkGoogle Scholar10. Medicare Payment Advisory Commission. The Medicare Advantage program: Status report. In: Medicare Payment Advisory Commission. Report to the Congress: Medicare Payment Policy. March 2016. Accessed at www.medpac.gov/docs/default-source/reports/chapter-12-the-medicare-advantage-program-status-report-march-2016-report-.pdf?sfvrsn=0 on 20 December 2016. Google Scholar Author, Article, and Disclosure InformationAffiliations: From Cedars-Sinai Medical Center, Los Angeles, California.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-2947.Corresponding Author: Teryl K. Nuckols, MD, MSHS, Division of General Internal Medicine, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Becker 113, Los Angeles, CA 90048; e-mail, teryl.[email protected]org.This article was published at Annals.org on 10 January 2017. 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Kane, MD, for the Health and Public Policy Committee of the American College of Physicians*Pay-for-performance programs may not improve health 7 March 2017Volume 166, Issue 5Page: 368-369KeywordsBehaviorDisclosureElectronic medical recordsHealth care qualityHealth care quality assessmentHealth information technologyMedicareMotivationResearch designSystematic reviews ePublished: 10 January 2017 Issue Published: 7 March 2017 Copyright & PermissionsCopyright © 2017 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...