The costs of quality reporting

Provider pay-for-performance initiatives aim to increase reimbursement to physicians and others who provide high-quality, low-cost care to patients. Medicare has two main programs for physicians to ahcieve these goals: (i) the Merit-Based Incentive Payment System (MIPS) and (ii) the Alternative Payment Models (APM).  MIPS measures cost and quality for smaller physicians groups whereas APM requires physicians to participate in accountable care organizations, bundled payment, or other alternatives to traditional fee-for-service payment.

In his Health Affairs blog post, however, Matt Fielder argue that MIPS is not likely to improve quality.  Physicians are able to choose their own quality measures which leads to (i) physicians choosing ‘easier’ measures–often screening measures, or (ii) physicians choosing measures they already know they are good at.   The article mentions that a number of observers–including MedPAC–have argued that MIPS is unlikely to improve quality while the administrative burden on physicians is likely to be large.

How large?

Notably, CMS estimates that providers will spend $694 million complying with MIPS reporting requirements for the 2018 performance year. External estimates of the administrative costs of prior quality reporting programs suggest that burdens could be even larger.

The authors also report a number of strategies to improve quality.  They are bullish on the benefits of APMs and ACOs–whereas I am a bit more skeptical that these approaches will truly improve quality of care.  I do agree with the authors that it is a good ideas to have clinician reporting to clinical data registries as it “…can generate benefits for the health care system as a whole by creating a knowledge base that can be used to identify strategies to improve patient care and that allows clinicians to compare themselves to their peers.”

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