Article Figures & Data
Tables
- Table 1
Comparison of Coding Outcomes for Domains of Merit-Based Incentive Payment System Measures
Dimension of Health Care Dimension of Quality Domain Definition No. (%) Structure Access Geographical and physical access Geographical or physical barriers faced in getting to health services 0 (0) Structure Access Availability The extent to which a health service provides facilities that meet the health needs of people 0 (0) Structure Access Affordability Financial barriers imposed on a person by a health care system/facility 0 (0) Structure Effectiveness Structural effectiveness The organization of a health facility that enables care to be delivered as intended 0 (0) Process Access Affordability Financial barriers imposed on a person during the receipt of care 4 (3) Process Access Availability The extent to which a health service provides services that meet the health needs of people 5 (3) Process Effectiveness Effectiveness of clinical care The effective application of knowledge based care (evidence based or legitimate care) 122 (78) Process Effectiveness Effectiveness of interpersonal care Appreciation of the patient’s personal experience of illness or health care 4 (3) Outcome Access Health status The clinical consequences of barriers in accessing care 0 (0) Outcome Access User evaluation Experiences of patients in accessing health care 1 (<1) Outcome Effectiveness User evaluation Experiences of patients in receiving heath care 1 (<1) Outcome Effectiveness Health status The clinical consequences of the care that was provided 19 (12)
Additional Files
The Article in Brief
Impact of Gaps in Merit-Based Incentive Payment System Measures on Marginalized Populations
Kyle Eggleton , and colleagues
Background Although pay-for-performance programs can lead to overall improvements in health outcomes, they may unintentionally worsen health disparities for marginalized populations. This study examines Medicare's Merit Based Incentive Payment System (MIPS) to determine if gaps exist with a focus on health disparities.
What This Study Found There are gaps related to measurement of access, patient experience, and interpersonal care, raising concerns that MIPS may fail to measure the broader aspects of health care quality and even risk worsening existing health disparities. A total of 143 of 270 MIPS measures applied to primary care, and most were related to aspects of clinical experience; most of the domains that reflected quality of primary care were not represented. Five of 12 domains had no applicable measures, and only 10 percent of the measures fell into another five domains of primary care.
Implications
- The authors conclude that for MIPS and similar pay-for-performance programs to have a positive effect on health outcomes for marginalized populations, policy makers should apply a theoretical framework to the measures in order to ensure the broad domains of quality, equality in particular, are included. Doing so, they assert, can help identify gaps and develop measures that incentivize addressing health disparities. In failing to do so, they warn, pay-for-performance measures may not achieve their goals of better quality health outcomes for all members of society.
