Dataset Information

MIPS in Residency? A Look at Merit-Based Incentives in an Internal Medicine Residency Outpatient Practice.

ABSTRACT:

Background

In January 2017, full implementation of the Medicare Access and CHIP Reauthorization Act (MACRA) Merit-based Incentive Payment System (MIPS) inspired us to introduce a similar incentivized model of value-based care into our internal medicine residency's outpatient practice.

Objective

To provide real-world experience in a value-based payment practice model, we provided monetary incentives to internal medicine residents for meeting inbox management expectations, timely reporting, and improvement in clinical outcome measures.

Methods

Thirty-seven residents were divided into 6 teams. Over a 5-month period, clinical goals were to reduce by 5% each teams' average number of patients with diabetes who had HbA1c > 9% and to raise by 10% the number of diabetes patients at target blood pressure. Goals for inbox management were established: all forms, notes, medication refills, and patient requests were expected to be complete at the end of each week. Teams received monetary bonuses based on compliance with reporting, management of inboxes, and progress toward clinical outcome goals.

Results

Every team improved their patients' blood pressure; however, no one reached the 10% target. Every team improved their patients' average HbA1c, and 2 teams surpassed the 5% goal. All teams met their weekly reporting goal, and half completed the inbox management tasks 100% of the time. Of the 26 participants who completed the survey, 22 (85%) favored continuing the program.

Conclusions

Providing monetary incentives in a team-based internal medicine residency model improved patient outcome measures and provided real-world exposure to incentivized value-based care.

SUBMITTER: Bolyard J

PROVIDER: S-EPMC6375335 | biostudies-literature | 2019 Feb

REPOSITORIES: biostudies-literature

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Publications

MIPS in Residency? A Look at Merit-Based Incentives in an Internal Medicine Residency Outpatient Practice.

Bolyard Jennifer J Viswanathan Vignesh V Fribourg Dani D Narayanan Rama R

Journal of graduate medical education 20190201 1

<h4>Background</h4>In January 2017, full implementation of the Medicare Access and CHIP Reauthorization Act (MACRA) Merit-based Incentive Payment System (MIPS) inspired us to introduce a similar incentivized model of value-based care into our internal medicine residency's outpatient practice.<h4>Objective</h4>To provide real-world experience in a value-based payment practice model, we provided monetary incentives to internal medicine residents for meeting inbox management expectations, timely re ...[more]

PMID: 30805102

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Project description:BACKGROUND: Few studies have systematically and rigorously examined the quality of care provided in educational practice sites. OBJECTIVE: The objectives of this study were to (1) describe the patient population cared for by trainees in internal medicine residency clinics; (2) assess the quality of preventive cardiology care provided to these patients; (3) characterize the practice-based systems that currently exist in internal medicine residency clinics; and (4) examine the relationships between quality, practice-based systems, and features of the program: size, type of program, and presence of an electronic medical record. DESIGN: This is a cross-sectional observational study. SETTING: This study was conducted in 15 Internal Medicine residency programs (23 sites) throughout the USA. PARTICIPANTS: The participants included site champions at residency programs and 709 residents. MEASUREMENTS: Abstracted charts provided data about patient demographics, coronary heart disease risk factors, processes of care, and clinical outcomes. Patients completed surveys regarding satisfaction. Site teams completed a practice systems survey. RESULTS: Chart abstraction of 4,783 patients showed substantial variability across sites. On average, patients had between 3 and 4 of the 9 potential risk factors for coronary heart disease, and approximately 21% had at least 1 important barrier of care. Patients received an average of 57% (range, 30-77%) of the appropriate interventions. Reported satisfaction with care was high. Sites with an electronic medical record showed better overall information management (81% vs 27%) and better modes of communication (79% vs 43%). CONCLUSIONS: This study has provided insight into the current state of practice in residency sites including aspects of the practice environment and quality of preventive cardiology care delivered. Substantial heterogeneity among the training sites exists. Continuous measurement of the quality of care provided and a better understanding of the training environment in which this care is delivered are important goals for delivering high quality patient care.

Project description:BackgroundAlthough supervision is an important part of residency training, its scope and how it relates to other types of support, such as mentoring, precepting and feedback, remain unclear. While clinical supervision consists of ongoing instructions and feedback in the workplace setting, educational supervision is a formalized component of postgraduate medical educational and supports the process that facilitates a trainee's progression throughout their training. Since medical specialties have different supervisory traditions, this study focuses on educational supervision in internal medicine. Our aim was to investigate what is known about educational supervision practices in internal medicine and the role of educational supervision in supporting residents' learning.MethodsWe conducted a scoping review of the literature on educational supervision in residency training in internal medicine based on Levac et al.'s modification of Arksey and O'Malley's six-step framework. The literature search was performed in the following databases: Medline, Embase, Web of Science and the Educational Resources Information Center. In addition, we conducted a handsearch in Medical Teacher and Google Scholar. We followed the PRISMA guidelines for systematic research.ResultsEighteen of the 3,284 identified articles were included in the analysis. We found few empirical studies describing how educational supervision is conducted and what effect routine educational supervision has on residents' learning. Our findings suggest that the terminology can be confusing and that educational supervision practices in internal medicine has a weak theoretical foundation.ConclusionThe distinction between educational supervision and other support structures, such as mentoring and feedback, has not been clearly defined in the research literature. We argue that shared terminology is needed to better understand current educational practices and to facilitate clear communication about how to help residents learn.

Project description:BackgroundWhile both administrators of pay-for-performance programs and practicing physicians strive to improve healthcare quality, they sometimes disagree on the best approach. The Medicare Access and CHIP Reauthorization Act of 2015 mandated the creation of the Merit-Based Incentive Payment System (MIPS), a program that incentivizes more than 700,000 physician participants to report on four domains of care, including healthcare quality. While MIPS performance scores were recently released, little is known about how primary care physicians (PCPs) and their practices are being affected by the program and what actions they are taking in response to MIPS.ObjectivesTo (1) describe PCP perspectives and self-reported practice changes related to quality measurement under MIPS and (2) disseminate PCP suggestions for improving the program.DesignQualitative study employing semi-structured interviews.ParticipantsTwenty PCPs trained in internal medicine or family medicine who were expected to report under MIPS for calendar year 2017 were interviewed between October 2017 and June 2018. Eight PCPs self-reported to be knowledgeable about MIPS. Seven PCPs worked in small practices.Key resultsMost PCPs identified advantages of quality measurement under MIPS, including the creation of practice-level systems for quality improvement. However, they also cited disadvantages, including administrative burdens and fears that practices serving vulnerable patients could be penalized. Many participants reported using technology or altering staffing to help with data collection and performance improvement. A few participants were considering selling small practices or joining larger ones to avoid administrative tasks. Suggestions for improving MIPS included simplifying the program to reduce administrative burdens, protecting practices serving vulnerable populations, and improving communication between program administrators and PCPs.ConclusionsMIPS is succeeding in nudging PCPs to develop quality measurement and improvement systems, but PCPs are concerned that administrative burdens are leading to the diversion of clinical resources away from patient-centered care and negatively impacting patient and clinician satisfaction. Program administrators should improve communication with participants and consider simplifying the program to make it less burdensome. Future work should be done to investigate how technical assistance programs can target PCPs that serve vulnerable patient populations and are having difficulty adapting to MIPS.

Dataset Information

MIPS in Residency? A Look at Merit-Based Incentives in an Internal Medicine Residency Outpatient Practice.

Background

Objective

Methods

Results

Conclusions

Publications

MIPS in Residency? A Look at Merit-Based Incentives in an Internal Medicine Residency Outpatient Practice.

Similar Datasets

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