- A new study by Eggleton et al. finds gaps in Merit-Based Incentive Payment System (MIPS) measures may worsen disparities between the quality of certain aspects of healthcare including patient access, experience, and interpersonal care.
While value-based payment systems were designed to spur quality improvements across the spectrum of care, evidence suggests new federal incentives may worsen health inequities for marginalized populations among physicians looking to focus on the easiest measures for reporting.
The American Academy of Family Physicians (AAFP) voiced related concerns in a recent letter to CMS suggesting gaps in MIPS measures be addressed in an effort to emphasize equity in care delivery across populations.
In the study published in the Annals of Family Medicine, researchers analyzed 143 MIPS measures to determine if domains reflecting the quality of primary care were sufficiently represented. Researchers found 5 of 12 domains had no applicable measures, and only 10 percent of measures fell into another 5 domains of primary care.
After developing this classification, researchers determined that several gaps in MIPS measures exist, specifically measures related to access and patient experience — which researchers posit could incidentally have a negative impact on marginalized populations.
“Marginalized populations face numerous barriers in accessing health care,” stated Eggleton et al. “These access issues include physical and geographical barriers, affordability barriers, and a lack of responsiveness from physicians.”
MIPS measures designed to encourage organizations to improve patient access to healthcare could close gaps in care for marginalized populations. However, these incentives do not presently exist.
“Mechanisms to mitigate against and address barriers in accessing primary care are likely to indicate a responsive primary care physician,” researchers added. “The absence of any meaningful measures specific to addressing access barriers for individual patients in MIPS may contribute to a lack of incentives to address these barriers.”
Another gap in MIPS quality measures — patient experience — could also negatively impact care quality improvements in marginalized communities.
The patient-provider relationship is as an integral aspect of patient care delivery with a potential to improve health outcomes. Without MIPS measures incentivizing patient experience, it is unlikely lackluster relationships between marginalized populations and providers will improve.
“In these groups, there is evidence that the quality of interpersonal health communication is poorer,” noted researchers. “Incorporating more person-focused measures rather than the current emphasis on disease-focused measures of MIPS may enable family physicians to better address aspects of practice that contribute to health disparities.”
MIPS is designed to improve care delivery through measures assessing health IT use and health outcomes, among other areas of care.
But the more subjective factors impacting day-to-day patient care are less of a focal point under the new system.
With these areas of weakness in mind, researchers suggest policymakers develop legislation to broaden the spectrum of MIPS quality measures.
“We would posit that for MIPS and similar pay-for-performance programs to have a positive effect on health outcomes for marginalized populations, there is a need for policy makers to apply a theoretical lens to the measures,” they researchers. “Applying a theoretical framework would involve ensuring that the broad domains of quality, equity in particular, are encapsulated by the proposed performance measures.”
Closing gaps in quality measures could decrease disparities between patient populations and improve overall care and health outcomes. If these gaps continue to go unresolved, inequities will only become more apparent.
“In neglecting to do so, pay-for-performance measures may fail in their objective of delivering better quality health outcomes for all members of society regardless of wealth, color, or personal circumstances,” advised researchers. “Even in the year of its inception, it is not too early for policy makers to be looking ahead toward improvements in MACRA and MIPS.”