Why implementing pay-for-performance is challenging

Medicare’s Merit-based Incentive Payment System (MIPS) aims to link physician quality of care to their reimbursement.  At first glance, paying more to high quality physicians seems like a great idea. However, a paper by Liao et al. (2018) surveys physicians from a large national sample maintained by the American College of Physicians (ACP).  They find some key concerns physicians have over MIPS:

Respondents reported believing that MIPS would encourage behaviors that could represent unintended consequences (results not shown). The majority believed that it would encourage physicians to “focus on aspects of care being measured to the detriment of other unmeasured aspects of care” (69 percent), “avoid sicker or more medically complex patients to improve performance on quality or utilization measures” (60 percent), and “change clinical documentation to improve performance on quality measures” (56 percent).

In part due to these concerns and the reporting burden it placed on physicians, the Medicare Payment Advisory Commitee (MedPAC) recommended eliminating MIPS and instead creating a voluntary value-based reimbursement scheme for physicians.


from Dental Tips https://www.healthcare-economist.com/2018/07/15/why-implementing-pay-for-performance-is-challenging/

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