Enhancing Healthcare Quality through Patient-Centered Outcome Measures in Medicare's Merit-based Incentive Payment System

OBJECTIVES: Medicare’s Merit-Based Incentive Payment System (MIPS) score evaluates and incentivizes physician performance across four weighted categories: quality, promoting interoperability, improvement activities, and cost combined into a composite score. The quality category includes patient-centered outcome measures (PCOMs), such as patient-reported outcomes, patient engagement, and/or patient experience measures. We described trends in the quality performance measures overall, with a focus on PCOMs.
METHODS: This is a descriptive study that utilizes publicly-available data on quality performance measures obtained from the Centers for Medicare and Medicaid Services Quality Payment Program tool (2020-2024). We describe and quantify the yearly percentage of the total quality measures and those categorized as PCOMs by performance year.
RESULTS: During the study period, the weighted value assigned to the quality performance category in the total MIPS score calculation decreased from 45% to 30%, and the total number of quality measures declined from 218 in 2020 to 196 in 2024. PCOMs represented nearly 10% of the reportable quality measures available throughout the study period. However, the count of PCOMs increased slightly, from 20 in 2020 to 23 in 2024. These PCOMs primarily assessed functional status in surgery, primary care, ophthalmology, and dermatology specialties.
CONCLUSIONS: There is an opportunity to increase the weight allocation for the quality performance category in MIPS and to modify the incentivization formula, promoting the reporting of more PCOMs by either mandating them or linking them to higher incentives under the MIPS program. Of concern, there is a lack of quality measures tailored to certain clinical specialties, such as mental health and substance use disorders where direct patient input could be crucial. Our work underscores the need to redesign the MIPS and prioritize patient-centered quality measures that directly capture patients' healthcare needs and ultimately enhance the quality of care provided.