Hospital-physician Integration and Value-based Payment

Abstract

Background: Hospital-physician integration is often justified as a driver of clinical quality improvement due to joint resources covering a broad spectrum of care. Value-based programs, such as the Medicare Merit-Based Incentive Payment System (MIPS), are intended to tie financial incentives to clinical quality, which may confer an advantage on such integrated practices. Objectives: We assessed the relationship between hospital-physician integration and MIPS performance by comparing hospital-integrated practices and independent practices. Research Design: This was a cross-sectional study using data from the Quality Payment Program for the performance year 2020. Subjects: Physician practices with a valid MIPS composite score in performance year 2020. Measures: Hospital integration was based on whether at least 75% of a practice’s physicians either billed most of their services using hospital outpatient department codes or billed through a hospital tax identifier. The primary outcome was the MIPS quality category score, and the secondary outcomes were the specific quality measures reported by practice groups. Results: Of the 20 most frequently reported measures, 14 were common in both groups. No difference was observed in the quality category score between hospital-integrated practices and independent practices in either unadjusted comparisons or after adjusting for practice characteristics, including practice size, geography, specialty mix, and case mix. In the secondary outcome models for specific quality measures, hospital-integrated practices achieved higher scores on most overlap measures but not all. Conclusions: The findings on quality category score suggest that hospital integration does not confer much advantage in the context of MIPS quality performance.