Article Abstract

US trainee perspectives on a national pay-for-performance program

Authors: Joshua M. Liao, Judy A. Shea, Arlene Weissman, Amol S. Navathe

Abstract

Background: As the largest national pay-for-performance program to date in the United States, the Medicare Merit-based Incentive Payment System (MIPS) will meaningfully affect US trainees as they enter clinical practice. However, trainee perspectives about this national pay-for-performance program remain unknown.
Methods: We conducted a web-based survey among 186 internal medicine residents and fellows from a national sample maintained by the American College of Physicians. The survey assessed perspectives about how physician efforts in four areas—reporting and performing well on clinical quality measures; initiating or participating in clinical practice improvement activities; controlling patients’ resource utilization; implementing and using electronic health records—impact the value of care when considered as general focus areas or components of MIPS. The survey also assessed other perspectives, including whether MIPS might prompt behaviors that represent unintended consequences.
Results: Of 393 eligible trainees, 186 (47%) responded. Most (76–84%) believed that physician efforts in the four focus areas would ultimately improve the value of patient care. Once informed that the four focus areas correspond to MIPS domains, slightly over half (57%) of respondents believed that MIPS policy would ultimately improve value. Most trainees believed that MIPS would encourage behaviors that could represent unintended consequences, such as focusing on aspects of care being measured to the detriment of other unmeasured aspects of care.
Conclusions: Trainee perspectives about MIPS and its underlying focus areas were generally positive, although this study highlights areas in which educators and practice leaders can further prepare trainees for such national pay-for-performance programs and provide feedback to improve policy design.