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

Authors

Shirley H. Fung, Department of Health, Human Function, and Rehabilitation Sciences, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA.
Timothy E. Stump, Department of Biostatistics and Health Data Science, School of Medicine, Indiana University, Indianapolis, IN, USA.
Adam Ciarleglio, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA.
Norman W. Gill, Department of Health, Human Function, and Rehabilitation Sciences, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA.

Document Type

Journal Article

Publication Date

10-24-2025

Journal

The Permanente journal

DOI

10.7812/TPP/25.099

Keywords

MIPS Value Pathways; Medicare; Merit-based Incentive Payment System; health care quality; orthopedic surgeons; quality measures; value-based incentive payments

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 = 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.

APA Citation

Fung, Shirley H.; Stump, Timothy E.; Ciarleglio, Adam; and Gill, Norman W., "Complex Patient Scores Meaningfully Affect 2022 Medicare Merit-Based Incentive Payment System Bonus Payments for Orthopedic Surgeons" (2025). GW Authored Works. Paper 8236.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/8236

Department

Biostatistics and Bioinformatics