Dr. Maganty on “unintended consequences” of MIPS program

In this video, Avinash Maganty, MD, shares the take-home message from the Urology Practice study, “Merit-Based Incentive Payment System Quality Reporting in Urology Practices.” Maganty is a Society of Urologic Oncology fellow at the University of Michigan, Ann Arbor.

Transcription:

What are the next steps for this research?

[MIPS] is certainly in its early days, and it's undergoing continuous change by [the Centers for Medicare & Medicaid Services] on an annual basis. Importantly, as Medicare is transitioning to a new iteration of MIPS, where they're now transitioning into condition-specific models, there is not one for urologic conditions. Most urologists will continue to be exposed to this program in the foreseeable future, and so our ongoing effort is focusing on how the program may be affecting care for patients with urologic conditions such as prostate cancer. We see on a larger scale that practices are being negatively affected. We want to understand, are there potential unintended consequences of this policy for the patient?

What is the take-home message for the practicing urologist?

I think there's concern that performance within this program may really be reflective of ability to track and report measures that larger practices that have financial capital and administrative infrastructure may be able to do more easily. Additionally, it is a potential concern that practices that care for a higher proportion of vulnerable patients and those who perform poorly change practices. I think there's a concern for the urologist that this policy could have some unintended consequences; for instance, increasing consolidation and loss of small urology practices. And these practices may often be those that are caring for these more vulnerable patients. And so that could be detrimental to patient access overall. I think this policy is here to stay, and Medicare is increasingly interested in maintaining or going away from volume toward value-based payment. I think it's important as urologists to try to understand how we fit into this scheme and how we can participate in value-based care in a meaningful way without negatively affecting patients. The way we participate may also really depend on our practice context. Those in smaller practice settings may not be able to engage in a certain type of model like those in larger settings. My thought is a one-size-fits-all approach to value-based payment may not really work. Moving forward, I think it's important to understand how we can participate in these models and what models will work best for what context.

This transcription was edited for clarity.