09/12/2022 11:07 Pay-for-Performance Measures Perform Poorly

SUMMARY AND COMMENT | GENERAL MEDICINE, AMBULATORY MEDICINE, HOSPITAL MEDICINE

INFORMING PRACTICE
December 8, 2022

Pay-for-Performance Measures Perform Poorly

Thomas L. Schwenk, MD, reviewing Bond AM et al. JAMA 2022 Dec 6 McWilliams JM. JAMA 2022 Dec 6

MIPS scores did not predict performance on several clinical process and outcome measures.

The Medicare Merit-Based Incentive Payment System (MIPS) affects reimbursement for nearly all
U.S. clinicians via penalties and bonuses for performance across several cost and quality measures.
However, clinicians and policy experts have questioned the relevance of MIPS scores to measuring
actual clinical performance. Investigators explored associations between MIPS scores and clinical
performance in a cross-sectional study that involved 80,000 primary care physicians who cared for 3.4
million patients. MIPS scores were classified as low (≤30), medium (>30–75), or high (>75), and
performance was measured on five clinical process measures (e.g., eye exam for patients with
diabetes, glycosylated hemoglobin testing, breast cancer screening), six risk-adjusted clinical
outcomes measures (e.g., ambulatory care–sensitive admissions), and a risk-adjusted composite
outcomes measure.

Physicians with low MIPS scores performed significantly worse than those with high scores on three
process measures but performed better on two measures. Only small differences were seen between
low and high scorers in performance on the clinical outcomes. Nineteen percent of physicians with
low MIPS scores performed in the top quintile of the composite measure, and 21% of physicians with
high MIPS scores performed in the bottom quintile.

COMMENT
Most of the critique of the MIPS program revolves around whether it should be revised or
replaced. An editorialist raises several reasons why using any program of penalties and bonuses
to improve clinical performance is theoretically unsound. These data tend to support that
assessment.

CITATIONS
Bond AM et al. Association between individual primary care physician merit-based incentive payment
system score and measures of process and patient outcomes. JAMA 2022 Dec 6; 328:2136.
(https://doi.org/10.1001/jama.2022.20619)

https://www.jwatch.org/na55604/2022/12/08/pay-performance-measures-perform-poorly 1/3
09/12/2022 11:07 Pay-for-Performance Measures Perform Poorly

McWilliams JM. Pay for performance: When slogans overtake science in health policy. JAMA 2022
Dec 6; 328:2114. (https://doi.org/10.1001/jama.2022.20945)

SHARE

DISCLOSURES

FURTHER READING

NOV 29, 2022

Allopurinol Dosing and Serious Cutaneous Reactions
Allan S. Brett, MD

NOV 23, 2022

New Classification Criteria for Giant Cell Arteritis
Allan S. Brett, MD

NOV 23, 2022

CDC Recommendations for Prescribing Opioids for Pain — Continued
Recalibration
Thomas L. Schwenk, MD

NOV 22, 2022

Does Subclinical Hyperthyroidism Predispose People to Fractures?
Thomas L. Schwenk, MD

NOV 17, 2022

Nephrologist Ownership of Dialysis Facilities and Clinical Outcomes
Paul S. Mueller, MD, MPH, FACP

Thomas L. Schwenk, MD
Associate Editor
NEJM JOURNAL WATCH GENERAL
MEDICINE

https://www.jwatch.org/na55604/2022/12/08/pay-performance-measures-perform-poorly 2/3
09/12/2022 11:07 Pay-for-Performance Measures Perform Poorly

Biography Disclosures Summaries

Stay Informed, with Concise, Evidence-

Based Information.
SUBSCRIBE

NEJM Journal Watch is produced by NEJM Group, a division of the Massachusetts Medical Society.
Copyright © 2022 Massachusetts Medical Society. All rights reserved.
The content of this site is intended for health care professionals. Copyright | Terms | Privacy Policy

https://www.jwatch.org/na55604/2022/12/08/pay-performance-measures-perform-poorly 3/3