Complex Patient Scores Meaningfully Affect 2022 Medicare Merit-Based Incentive Payment System Bonus Payments for Orthopedic Surgeons

Abstract

Introduction: The Merit-Based Incentive Payment System (MIPS) affects Medicare reimbursements for over 600,000 clinicians, including ~ 15,000 orthopedic surgeons in the United States. MIPS policies are rapidly evolving, yet limited research exists to guide orthopedic surgeons in optimizing performance. This study evaluates whether recent MIPS policy changes have led to increased payment adjustments for orthopedic surgeons and examines the role of MIPS in enhancing care quality. Methods: A retrospective analysis of 2021-2022 MIPS performance data from nearly 9000 orthopedic surgeons assessed the impact of policy changes on payment adjustments using McNemar's test and mixed effects logistic regression. Results: Raising the MIPS performance threshold to 75 points significantly reduced the likelihood of receiving bonus payments (χ 2 = 803.21, degrees of freedom = 1; P < .01). Surgeons in smaller practices had 60% lower odds of earning bonus payments (odds ratio, 0.40; 95% confidence interval, 0.33-0.48; P < .008), though this disparity was smaller than previously reported. The updated complex patient bonus scoring policy showed the strongest positive effect on the likelihood of receiving bonus payments (odds ratio, 6.49; 95% confidence interval, 3.31-12.76; P < .017). Nonetheless, MIPS continues to fall short in encouraging the reporting of specialty-specific, outcome-based, and patient-experience measures. Discussion: Raising the MIPS performance threshold further may lead to greater dissatisfaction. Despite some improvements, equity gaps remain for small and rural practitioners. However, the revised complex patient bonus policy effectively rewards clinicians caring for high-risk populations.