“[MIPS represents] a significant paradigm shift away from the traditional fee-for-service model and toward the concept of value-based care," wrote Ridwan Alam, MD, MPH, and coauthors.
A recent study analyzed the differences in compensation between urologists of varying participation statuses since the initiation of the new Merit-based Incentive Payments System (MIPS).1,2
Urologists who participated as a group practice or alternative payment model (APM) demonstrated higher MIPS scores than those in an individual practice.
“[MIPS represents] a significant paradigm shift away from the traditional fee-for-service model and toward the concept of value-based care," wrote Ridwan Alam, MD, MPH, and coauthors. Now, the investigators add, "physicians may need to compete for revenue.”
Using data from the 2018 MIPS database, investigators stratified urologists by participation status (group, APM, individual) and scored them based on the following MIPS categories: Quality, Promoting Interoperability (PI), Cost, and Improvement Activities (IA). The IA score has a maximum of 40 points and the rest have a maximum of 100 points.
Tukey’s honest significance test and chi-square analysis were used as methods of comparative analyses, and multinominal logistic regression was performed to evaluate correlations between MIPS scores and demographics.
Of the 9055 urologists included in this cross-sectional study, 47.0% participated in group practice, 32.4% participated in an APM, and 20.6% participated in an individual practice. The majority of urologists were male (91.2%) and graduated from medical school on or after 1980 (86.3%).
Results showed that the average MIPS score (max 100) across all groups was 82.5 for Quality, 88.9 for PI, 74.4 for Cost, and 37.3 for IA (P < .001). Most notably, urologists practicing individually scored lower in all categories compared to group or APM urologists (Quality, 57.5, 84.9, and 94.3 for individual, group, and APM, respectively; PI, 61.2, 94.3, and 97.1; Cost, 72.8, 74.7, and 72.7; IA, 28.5, 39.4, and 39.7).
According to the authors, “The lower MIPS scores for urologists in individual practice may stem from fewer resources, compared to large group or academic practices.”
Initial findings additionally suggested that there was a greater number of male urologists in individual practices than females (1352 vs 86; P < .001) and a greater number of female urologists in group practices than any other practice type (317 group, 86 individual, 202 APM; P < .001).
Practice preference was significantly affected by year of graduation from medical school as well. Urologists who graduated prior to 1990 were more likely to participate in individual practices than those who graduated after 1990. The APM was most popular for urologists graduating in 2010 or after.
In terms of geographic location, on univariable regression, individual practices were found more in the Southeastern and Western sections of the American Urological Association than expected (Southeastern, –8.8, 95% CI, –11.6- –6.0; P < .001; Western, –11.7, 95% CI, –14.6- –8.8; P < .001), whereas the North Central section had far fewer individual practices (0.0 points, 95% CI, –2.9-2.9; P = .99).
After performing multivariable regressions, sex of urologist was no longer associated with preference for practice type, the year of graduation played a much larger role in preference (recent graduates more likely to choose group or APM practices), and location continued to be a contributing factor to evaluation (urologists in the Northeastern or North Central locations were 4 to 5 times more likely to choose group over individual practice, P < .001).
Taking all of the statistical analyses into account, the authors concluded that the "introduction of a new reimbursement schedule will likely result in further evolution of practice patterns in the future."
1. Alam R, Clifton MM, Han M. Urologist scores in the era of the merit-based incentive payment systems (MIPS). Urol Pract. Published online January 24, 2022. doi:10.1097/UPJ.0000000000000285
2. For urologists, new payment system may contribute to changing practice patterns. News release. Wolters Kluwer Health. January 24, 2022. Accessed January 28, 2022. https://www.eurekalert.org/news-releases/941057