Date of Award

January 2021

Document Type


Degree Name

Medical Doctor (MD)



First Advisor

Arjun K. Venkatesh


The Merit-Based Incentive Payment System (MIPS) is the largest change to physician reimbursement in decades. We sought to examine clinician participation and performance of clinicians to better understand the relationship between clinician features and reporting decisions on MIPS scores and payment adjustments.

Using publicly available data from the Centers for Medicare and Medicaid Services (CMS), we examined 2018 clinician participation and performance in the MIPS. We analyzed aggregate MIPS score performance as well as payment adjustment results stratified by clinician specialty, reporting affiliation, practice size, and the CMS special status designating rural or health profession shortage area (HPSA). Using linear regression analysis, we examined the impact of reporting through qualified clinical data registries (QCDRs) on the Quality performance category score. With logistic regression, we assessed the likelihood of exceptional payment adjustments based on use of QCDRs.

Across all specialties, we found that 98.6% of clinicians participating in the MIPS achieved positive or exceptional payment adjustments. The only clinician-level characteristic associated with significantly lower composite MIPS scores and payment adjustments is reporting affiliation. Clinicians reporting as part of MIPS alternative payment models (MIPS APMs) (median, [IQR], 100, [100-100]) and Groups (96.3, [76.9-100) achieved higher scores than clinicians reporting as individuals (80.0, [39.4-98.4]). This translated into significantly higher odds of clinicians reporting as individuals receiving negative or neutral payment adjustments relative to Groups or MIPS APMs (OR [p-value], 56.5 [p<0.001]). We found that reporting through qualified clinical data registries has variable impact on Quality performance category scores and MIPS paymentadjustments, with both magnitude and direction of the effect depending on medical specialty. The greatest association between QCDR use on score and exceptional payment adjustment was seen in Emergency Medicine. Measure-level analysis of commonly scored measures by Emergency Medicine clinicians demonstrates higher decile scores of common QCDR measures and general CMS Quality Payment Program measures over CMS measures designated for Emergency Medicine (Emergency Medicine Specialty Set).

We concluded that organizational features of providers and how they report into the MIPS are associated with program performance and the resulting payment adjustments. Depending on clinician specialty there is potential economic benefit of using QCDRs in specialties like Emergency Medicine if the clinician does not qualify for exceptional payment adjustments or is at the margin of the bonus threshold.


This thesis is restricted to Yale network users only. It will be made publicly available on 10/12/2022