Dermatologists who have a greater percentage of patients from multiple patient social categories have lower Merit-Based Incentive Payment System (MIPS) scores, according to a study in the Journal of the American Academy of Dermatology.

MIPS was created in 2017 to link physician remuneration with a number of performance metrics. Final MIPS scores range from 0 to 100 and represent a weighted average of physician performance.

The study authors reviewed data from the 2017 Medicare Public Use and Individual MIPS Performance datasets and assessed final MIPS scores based on the percentage of non-White minority beneficiaries, proportion of dual Medicare-Medicaid beneficiaries, and local dermatologic access. MIPS scores were summarized for dermatologists who managed a high percentage of patients within each social group.


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A total of 8085 dermatologists (55.3% men) were included in the analysis. Among the sample, 41.1% clinicians had 10 to 24 years of independent practice, 36.9% had 400 to 799 beneficiaries, 94.6% practiced in a metro setting, and 53.6% were in a small group dermatology practice.

The adjusted MIPS score for the entire sample was 66.5. Dermatologists in the top quartile for proportion of non-White minority beneficiaries had an adjusted MIPS score of 61.2, and those with 10% or greater Hispanic beneficiary distribution had a score of 47.6, those with 10% or greater Asian/Pacific Islander beneficiary distribution had a score of 55.3, and those with 10% or greater non-Hispanic Black beneficiary distribution had a score of 64.0.

Dermatologists who were in the top quartile for limited dermatologists in a county had an adjusted MIPS score of 63.0, and those in the top quartile for percentage of dual Medicare and Medicaid beneficiaries had an adjusted MIPS score of 67.0.

Dermatologists who had a greater percentage of patients from all assessed social categories had lower MIPS scores. Those in the highest quartile for dual Medicare-Medicaid beneficiaries commonly practiced in small dermatology settings (32.3%) and academic groups (26.3%), and those in the top quartile for limited dermatologic access were primarily located in small dermatology groups (55.6%). Regarding dermatologists in the top quartile for all social categories, those in academic practices and MIPS alternative payment models had higher MIPS scores.

“The demonstrated relationship between MIPS scores and patient social factors is reflective of that in other medical specialties and supports the complexities of managing underserved patients,” stated the study authors.

The investigators noted several shortcomings related to their findings. The limited number of social measurements may not fully reflect the socioeconomic dynamics that affect MIPS performance. Also, having non-White beneficiaries in a single category may mask important findings within each specific racial/ethnic group, and Medicaid-only beneficiaries are not included.

Disclosures: One study author declared affiliations with the biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Gronbeck C, Feng PW, Feng H. Evaluation of dermatologist performance in the 2017 merit-based incentive payment system based on patient social factors. J Am Acad Dermatol. Published online March 1, 2021. doi:10.1016/j.jaad.2021.02.065