Plastic Surgeons and Equity: Are Merit-based Incentive Payment System (MIPS) Scores Impacted by Minority Patient Caseload?

BACKGROUND: The Centers for Medicare and Medicaid Services introduced the Merit-Based Incentive Payment System (MIPS) in 2017 to extend value-based payment to outpatient physicians. We hypothesized that the MIPS scores for plastic surgeons are impacted by the existing measures of patient disadvantage, minority patient caseload and dual eligibility.

METHODS: We conducted a retrospective cohort study of plastic surgeons participating in Medicare and MIPS using the Physicians Compare National Downloadable File and MIPS scores. Minority patient caseload was defined as non-white patient caseload. We evaluated the characteristics of participating plastic surgeons, their patient caseloads and their scores.

RESULTS: Of 4,539 plastic surgeons participating in Medicare, 1,257 participated in MIPS in the first year of scoring. The average patient caseload is 85% White, with racial/ethnicity data available for 73% of participating surgeons. In multivariable regression, higher minority patient caseload is associated with a lower MIPS score.

CONCLUSIONS: As minority patient caseload increases, MIPS scores decrease for otherwise similar caseloads. CMS must consider existing and additional measures of patient disadvantage to ensure equitable surgeon scoring.