Importance Integration of physician practices into health systems composed of hospitals and multispecialty practices is increasing in the era of value-based payment. It is unknown how clinicians who affiliate with such health systems perform under the new mandatory Centers for Medicare & Medicaid Services Merit-based Incentive Payment System (MIPS) relative to their peers. Objective To assess the relationship between the health system affiliations of clinicians and their performance scores and value-based reimbursement under the 2019 MIPS. Design, Setting, and Participants Publicly reported data on 636 552 clinicians working at outpatient clinics across the US were used to assess the association of the affiliation status of clinicians within the 609 health systems with their 2019 final MIPS performance score and value-based reimbursement (both based on clinician performance in 2017), adjusting for clinician, patient, and practice area characteristics. Exposures Health system affiliation vs no affiliation. Main Outcomes and Measures The primary outcome was final MIPS performance score (range, 0-100; higher scores intended to represent better performance). The secondary outcome was MIPS payment adjustment, including negative (penalty) payment adjustment, positive payment adjustment, and bonus payment adjustment. Results The final sample included 636 552 clinicians (41% female, 83% physicians, 50% in primary care, 17% in rural areas), including 48.6% who were affiliated with a health system. Compared with unaffiliated clinicians, system-affiliated clinicians were significantly more likely to be female (46% vs 37%), primary care physicians (36% vs 30%), and classified as safety net clinicians (12% vs 10%) and significantly less likely to be specialists (44% vs 55%) (P < .001 for each). The mean final MIPS performance score for system-affiliated clinicians was 79.0 vs 60.3 for unaffiliated clinicians (absolute mean difference, 18.7 [95% CI, 18.5 to 18.8]). The percentage receiving a negative (penalty) payment adjustment was 2.8% for system-affiliated clinicians vs 13.7% for unaffiliated clinicians (absolute difference, -10.9% [95% CI, -11.0% to -10.7%]), 97.1% vs 82.6%, respectively, for those receiving a positive payment adjustment (absolute difference, 14.5% [95% CI, 14.3% to 14.6%]), and 73.9% vs 55.1% for those receiving a bonus payment adjustment (absolute difference, 18.9% [95% CI, 18.6% to 19.1%]). Conclusions and Relevance Clinician affiliation with a health system was associated with significantly better 2019 MIPS performance scores. Whether this represents differences in quality of care or other factors requires additional research.

中文翻译：

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临床医生卫生系统从属关系与基于医疗保险绩效的奖励支付系统中门诊绩效评级的关联

重要性 在以价值为基础的支付时代，医生实践与由医院和多专业实践组成的卫生系统的整合正在增加。目前尚不清楚隶属于此类卫生系统的临床医生在新的强制性医疗保险和医疗补助服务中心绩效奖励支付系统 (MIPS) 下相对于同行的表现如何。目的 评估 2019 年 MIPS 下临床医生的卫生系统从属关系与其绩效评分和基于价值的报销之间的关系。设计，设置，和参与者 公开报告的在美国门诊诊所工作的 636 552 名临床医生的数据用于评估 609 个卫生系统内临床医生的从属地位与其 2019 年最终 MIPS 绩效评分和基于价值的报销（均基于临床医生2017 年的表现），根据临床医生、患者和实践领域的特点进行调整。接触卫生系统从属关系与无从属关系。主要结果和措施 主要结果是最终的 MIPS 性能得分（范围，0-100；更高的分数旨在代表更好的性能）。次要结果是 MIPS 支付调整，包括负（罚款）支付调整、正支付调整和奖金支付调整。结果 最终样本包括 636 552 名临床医生（41% 女性，83% 医生，50% 在初级保健，17% 在农村地区），其中 48.6% 隶属于卫生系统。与非附属临床医生相比，系统附属临床医生更可能是女性（46% 对 37%）、初级保健医生（36% 对 30%）和被归类为安全网临床医生（12% 对 10%）和显着不太可能成为专家（44% 对 55%）（每个 P < .001）。系统附属临床医生的平均最终 MIPS 绩效得分为 79.0 与非附属临床医生的 60.3（绝对平均差异，18.7 [95% CI，18.5 至 18.8]）。系统附属临床医生接受负（罚款）付款调整的百分比为 2.8%，非附属临床医生为 13.7%（绝对差异，-10.9% [95% CI，-11.0% 至 -10.7%]），97.1% 与 82.6% ％， 分别，对于那些接受正支付调整的人（绝对差异，14.5% [95% CI，14.3% 至 14.6%]），而对于那些接受奖金支付调整的人，73.9% 与 55.1%（绝对差异，18.9% [95% CI， 18.6% 到 19.1%]）。结论和相关性 临床医生隶属于卫生系统与 2019 年 MIPS 绩效得分显着提高相关。这是否代表护理质量或其他因素的差异需要进一步研究。