新研究：患者社会风险越高，医生绩效得分越低 作者： 发布时间：/9/12 21:44:28 美国威尔康奈尔医学院Lawrence P. Casalino团队分析了基于绩效的激励支付系统实施第一年间患者社会风险与医生绩效得分之间的相关性。9月8日，该研究发表在《美国医学会杂志》上。
美国基于绩效的激励支付系统（MIPS）是一项基于医疗保险价值的重要支付项目，旨在提高质量和降低成本。医生绩效是否会因患者社会风险而变化，这一点尚未明确。
为了评估患者社会风险与临床医生第一年MIPS绩效评分的关系，研究组对参与MIPS的医师进行了一项横断面研究。主要结果是MIPS综合得分（范围0-100；分数越高表现越好）。付款率基于评分进行-4%到4%的调整。研究组共分析了284544名医生，其中76.1%为男性，60.1%从医超过，11.9%处于农村，26.8%基于医院，24.6%为初级保健者。
平均MIPS总得分为73.3分。最高风险五分位的医生治疗了52.0%的符合医疗保险和医疗补助双重资格的患者，中间风险五分之三的医生治疗了21.8%，最低风险五分位的医生治疗了6.6%。校正医疗复杂性后，最高风险五分位的医生平均MIPS得分为64.7分，显著低于中间风险五分之三的医生（75.4分）和最低风险五分位的医生（75.9分）。这种关系在除精神病学外的各科室中均是如此。
与最低风险五分位的医生相比，最高风险五分位的医生更有可能在农村工作（12.7%与6.4%），较小概率照顾超过1000名医保受益人（9.4%与17.8%），较小概率从医超过（56.7%与70.6%），差异均具有统计学意义。对于最高风险五分位的医生，几个特征与较高的MIPS评分相关，包括执业群体更大（50名以上的医生平均得分为82.4分，1-5名医生平均得分为46.1分）和通过替代支付模式（替代支付模式平均得分为79.5分，个人报告平均得分为59.9分）。
总之，对于参加医疗保险MIPS项目第一年的医生，符合医疗保险和医疗补助双重资格的患者比例最高的医生与其他医生相比，MIPS绩效得分明显较低。
附：英文原文
Title: Association Between Patient Social Risk and Physician Performance Scores in the First Year of the Merit-based Incentive Payment System
Author: Dhruv Khullar, William L. Schpero, Amelia M. Bond, Yuting Qian, Lawrence P. Casalino
Issue Volume: /09/08
Abstract:
Importance The US Merit-based Incentive Payment System (MIPS) is a major Medicare value-based payment program aimed at improving quality and reducing costs. Little is known about how physicians performance varies by social risk of their patients.
Objective To determine the relationship between patient social risk and physicians scores in the first year of MIPS.
Design, Setting, and Participants Cross-sectional study of physicians participating in MIPS in .
Exposures Physicians in the highest quintile of proportion of dually eligible patients served; physicians in the 3 middle quintiles; and physicians in the lowest quintile.
Main Outcomes and Measures The primary outcome was the composite MIPS score (range, 0-100; higher scores indicate better performance). Payment rates were adjusted 4% to 4% based on scores.
Results The final sample included 284544 physicians (76.1% men, 60.1% with 20 years in practice, 11.9% in rural location, 26.8% hospital-based, and 24.6% in primary care). The mean composite MIPS score was 73.3. Physicians in the highest risk quintile cared for 52.0% of dually eligible patients; those in the 3 middle risk quintiles, 21.8%; and those in the lowest risk quintile, 6.6%. After adjusting for medical complexity, the mean MIPS score for physicians in the highest risk quintile (64.7) was lower relative to scores for physicians in the middle 3 (75.4) and lowest (75.9) risk quintiles (difference for highest vs middle 3, 10.7 [95% CI, 11.0 to 10.4]; highest vs lowest, 11.2 [95% CI, 11.6 to 10.8]; P .001). This relationship was found across specialties except psychiatry. Compared with physicians in the lowest risk quintile, physicians in the highest risk quintile were more likely to work in rural areas (12.7% vs 6.4%; difference, 6.3 percentage points [95% CI, 6.0 to 6.7]; P .001) but less likely to care for more than 1000 Medicare beneficiaries (9.4% vs 17.8%; difference, 8.3 percentage points [95% CI, 8.7 to 8.0]; P .001) or to have more than 20 years in practice (56.7% vs 70.6%; difference, 13.9 percentage points [95% CI, 14.4 to 13.3]; P .001). For physicians in the highest risk quintile, several characteristics were associated with higher MIPS scores, including practicing in a larger group (mean score, 82.4 for more than 50 physicians vs 46.1 for 1-5 physicians; difference, 36.2 [95% CI, 35.3 to 37.2]; P .001) and reporting through an alternative payment model (mean score, 79.5 for alternative payment model vs 59.9 for reporting as individual; difference, 19.7 [95% CI, 18.9 to 20.4]; P .001).
Conclusions and Relevance In this cross-sectional analysis of physicians who participated in the first year of the Medicare MIPS program, physicians with the highest proportion of patients dually eligible for Medicare and Medicaid had significantly lower MIPS scores compared with other physicians. Further research is needed to understand the reasons underlying the differences in physician MIPS scores by levels of patient social risk.
DOI: 10.1001/jama..13129
Source:
期刊信息
JAMA-Journal of The American Medical Association：《美国医学会杂志》，创刊于1883年。隶属于美国医学协会，最新IF：51.273
官方网址：
投稿链接：
