Impact of quality payment program on providers’ performance

Clinicians who treat Traditional Medicare (TM) beneficiaries are paid based on the fee predetermined for each service. This payment method is said to be one of the reasons for the rise in health care costs. To minimize the rise in health care costs and improve quality of care, TM has been trying to change its payment method. TM started the Quality Payment Program (QPP) in 2017. QPP expects to decrease health care costs by rewarding clinicians with bonus payment if they perform as per the performance standards on cost and quality of care set by the program. Clinicians have options of either participating in Advanced Alternative Payment Models (APMs) and Merit-based Incentive Payment System (MIPS) payment tracks. Advanced APM track is for clinicians who are participating in APMs that take financial responsibility of their assigned patients. MIPS applies to clinicians who are not part of APMs or participating in APMs that do not take any financial responsibility of their patients. These two QPP tracks receive different types and size of bonus payments. QPP also assesses the performance of clinicians participating in these two QPP track differently.

This dissertation examines the effect of bonus payments on the performance of clinicians participating in either of the QPP tracks. There are different APMs that are eligible for the Advanced APM track. ACOs are one of the major APMs in TM. Therefore, we used clinicians participating in ACOs to compare their performance with those in MIPS track. The first aim of the dissertation compares the use of preventive services by clinicians participating in the ACO and MIPS tracks. For the second aim, we compared the Medicare B medical services payments received by ACO and MIPS providers. The third aim studies whether clinicians participating in the MIPS track could report more measures to improve their odds of receiving exceptional performance bonus payments.