Evaluating the impact of MIPS on marginalized populations

Abstract

Introduction There is limited evidence demonstrating that performance incentive programs result in improved patient outcomes and experience. For marginalized populations performance incentive programs may result in greater inequities. With the introduction of the Medicare Access and CHIP Reauthorization Act (MACRA), in the US, it is important to evaluate the merits and limitations of MACRA’s Merit Based Incentive Payment System (MIPS) with regards to capture of essential elements of primary care and the potential to diminish health inequities for marginalized populations. Methods A directed content analysis approach was taken to categorize individual MIPS measures. The structured coding matrix used was taken from a theoretical model of quality healthcare. All primary care specific MIPS measures were coded by using the structured coding matrix. A taxonomy of MIPS measures was then developed from the codes and rank order comparisons used to describe the categories within the taxonomy. Results The majority of MIPS measures related to aspects of clinical effectiveness. There were few, if any measures that related to aspects of access, patient experience or interpersonal care. Conclusion The dominance of MIPS measures that relate to clinical effectiveness indicate a lack of consumer engagement and the dominance of medical specialities in the development of measures. The absence of measures that relate to cultural competency, socioeconomic disadvantage and interpersonal skills suggests that MIPS may fail to address health disparities between marginalized populations and the general population and in turn contribute to ongoing inequities.