Physician outcome measures do not accurately gauge ophthalmologists’ quality
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Researchers found current Merit-based Incentive Payment System and future public reporting of physician scores for outcome measures used flawed methodology, questioning its ability to differentiate between high- and low-performing ophthalmologists.
In this study, John T. Thompson, MD, assistant professor at The Wilmer Institute of The Johns Hopkins University and associate clinical professor at The University of Maryland, and colleagues examined the reliability of all 29 current Medicare Merit-based Incentive Payment System (MIPS) clinical quality outcome measures for ophthalmology by comparing expected differences between higher and lower performing ophthalmologists.
Thompson and colleagues found that Medicare uses MIPS to reward perceived high-quality ophthalmologists with bonuses in reimbursement.
“Quality is the highest weighted category in MIPS. High-quality physicians are regarded with higher Medicare reimbursements, but what makes a physician high quality?” Thompson said during his presentation at the virtual American Society of Retina Specialists meeting. “Low-quality physicians are economically punished with reduced Medicare payments for all their Medicare patients.”
The researchers also found that 26 of 29 ophthalmology outcome measures have no established benchmarks as of the 2019 reporting period.
Thompson said that Medicare has been removing previously accepted ‘process measures’ – including recommending AREDS supplements or communicating with the primary care physician – in support of outcome measures; however, there are major limitations in the application of current outcome measures to individual physicians. This is because of small sample sizes, differences in clinical outcomes and lack of risk adjustments, according to Thompson.
“CMS believed measuring patient outcome would allow them to distinguish ‘good’ from ‘bad’ physicians,” Thompson said. “CMS takes the individual retina specialist outcomes and divides them into deciles, awarding 3 to 10 points. The problem is that the rules CMS have applied make it impossible for most retina specialists to use many of these retina outcome measures.”
For example, to be counted for measures with a 90-day look-back, Medicare requires that at least 20 cases be performed in the first 9 months of the calendar year; however, many retina specialists would not achieve this based on typical surgical volumes for epiretinal membrane and macular hole measures, according to Thompson.
“It’s very important that these measures do not discourage physicians from taking care of disadvantaged patients ... and to realize that comparing two individual physicians quality of care is meaningless with the current rules and certainly does not justify paying one physician better than the other,” Thompson concluded.
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Thompson JT, et al. Physician quality outcome measures don’t reliably measure quality for individual ophthalmologists. Presented at: American Society of Retina Specialists annual meeting; July 24-26, 2020 (virtual meeting).
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