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The Merit Based Incentive Payment System: Exposing the Disparity Among Providers Who Serve Dual Eligible Beneficiaries

Duncan, Mary Kate (2020) The Merit Based Incentive Payment System: Exposing the Disparity Among Providers Who Serve Dual Eligible Beneficiaries. Master Essay, University of Pittsburgh.

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Healthcare systems are moving towards a higher level of provider accountability for the quality and outcomes of care. In achieving this mission, The Centers for Medicare and Medicaid has implemented various value-based purchasing models including: The Physician Quality Reporting System, Hospital Value-Based Purchasing Model, and The Merit Based Incentive Payment System (MIPS). MIPS is one of the largest programs and is built off of the value-based payment models that exists in nearly all Medicare settings. The system was created to analyze clinical quality measures, but the concern centers around it failing to address social risk factors such as income, race, and other social determinants of health.
Providers that disproportionately serve vulnerable populations such as dual eligible patients, are at a great risk of being financially penalized under MIPS. The dual eligible population, those who qualify for both Medicare and Medicaid, have many barriers such as lack of transportation and disabilities that prevent them from accessing care. These factors, known as the social determinants of health, are unmeasured in Medicare claims data but are associated with health outcomes and impact providers performance. Since MIPS fails to address these public health factors, providers who serve a disproportionate share of medically and socially complex patients are more likely to receive a financial penalty compared to their peers who do not serve this population. In order to align payments and ensure value-based purchasing programs achieve their intended goals, the relationship between social risks and performance metrics needs to be better understood and aligned.


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Item Type: Other Thesis, Dissertation, or Long Paper (Master Essay)
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Duncan, Mary Kate
ContributionContributors NameEmailPitt UsernameORCID
Committee ChairRoberts, Ericeric.roberts@pitt.eduUNSPECIFIEDUNSPECIFIED
Committee MemberMaseru, Noblenam137@pitt.eduUNSPECIFIEDUNSPECIFIED
Date: 26 March 2020
Date Type: Submission
Number of Pages: 32
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Health Policy & Management
Degree: MPH - Master of Public Health
Thesis Type: Master Essay
Refereed: Yes
Date Deposited: 03 Sep 2020 01:08
Last Modified: 03 Sep 2020 01:08


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