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SLU Researcher Dives Into Medicare's Merit-Based Incentive Payment System

by Maggie Rotermund
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Maggie Rotermund
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maggie.rotermund@slu.edu
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Kenton Johnston, Ph.D., an associate professor of health management and policy at Saint Louis University’s College for Public Health and Social Justice, recently conducted two studies into how Medicare’s Merit-Based Incentive Payment System (MIPS) impacts clinicians.

The research was published online Sept. 8 in the Journal of the American Medical Association (JAMA) and Health Affairs

MIPS, which is authorized under the Medicare Access and CHIP Reauthorization Act, is a mandatory pay-for-performance program for clinicians participating in Medicare in the outpatient setting. Clinician performance under MIPS looks at quality of care, meaningful use of electronic health records, improvement activities for patient care processes and cost.

Kenton Johnston, Ph.D.

Kenton Johnston, Ph.D., is an associate professor of health management and policy at Saint Louis University College for Public Health and Social Justice. Submitted Photo.

JAMA

A team of researchers, led by Johnston, conducted a study investigating the association between health system affiliations of clinicians and their performance scores and payments under Medicare value-based reimbursement.

“Association of Clinician Health System Affiliation with Outpatient Performance Ratings in the Medicare Merit-based Incentive Payment System,” was published online Sept. 8 in the Journal of the American Medical Association.

The researchers found that clinicians who were affiliated with health systems had better performance scores and received fewer payment penalties and more payment bonuses under the Medicare Merit-based Incentive Payment System (MIPS) than clinicians not affiliated with health systems.

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Health Affairs 

Johnston and another team of researchers conducted a study to investigate how outpatient clinicians that treated disproportionately high caseloads of socially at-risk Medicare patients (safety-net clinicians) performed under Medicare’s Merit-Based Incentive Payment System.

Their findings, “Clinicians With High Socially At-Risk Caseloads Received Reduced Merit-Based Incentive Payment System Scores,” were published online Sept. 8 in Health Affairs.

The researchers found that clinicians treating high (top quintile) caseloads of Medicare patients dually-enrolled in Medicaid had performance scores 13.4 points lower than clinicians treating low (bottom quintile) caseloads of such patients, on a scale from 0-100. Clinicians with high caseloads of dually-enrolled patients were 99 percent more likely to receive a negative payment adjustment, and were 52 percent less likely to receive an exceptional performance bonus payment, than their peers with low caseloads of such patients.

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The Saint Louis University College for Public Health and Social Justice is the only academic unit of its kind, studying social, environmental and physical influences that together determine the health and well-being of people and communities. It also is the only accredited school or college of public health among nearly 250 Catholic institutions of higher education in the United States.

Guided by a mission of social justice and focus on finding innovative and collaborative solutions for complex health problems, the College offers nationally recognized programs in public health, social work, health administration, applied behavior analysis, and criminology and criminal justice.