Physician Performance in the Merit-Based Incentive Payment System: Implications for Health Disparities

Abstract

The Merit-based Incentive Payment System (MIPS) is ostensibly designed to promote better care across participants. However, MIPS risks exacerbating disparities among participants with fewer resources to invest in performance metrics like care delivery improvements or quality reporting. Unfortunately, little is known about how group practice characteristics impacted MIPS scores and associated reimbursement in later years of implementation. Two practice-level characteristics (location in urban areas and larger patient populations) and two community-level characteristics (some college education and health care spending) were positively associated with MIPS scores. In contrast, patient population case mix and the proportion of Medicare/Medicaid dual-eligible patients were negatively associated with MIPS scores at the practice-level. These findings underscore the potential risk that MIPS may exacerbate health disparities by penalizing practices caring for lower-income populations adversely affected by social drivers of health.