http://altarum.org/health-policy-blog/unintended-consequences

How does it feel knowing the clinical decisions our physicians make affect their pocketbook? MIPS, or the Merit-based Incentive Payment System, is now the law of the land. MIPS attempts to incentivize physicians based on quality measures, use of electronic health records, practice improvement approaches and cost of care. The Centers for Medicare and Medicaid (CMS), is tasked with working out the details of the program, which aims to take us from a system where physicians are incentivized to “do something” to patients to one in which “quality” is the predominate goal.

Here’s my quandary: As a Geriatrician, I have practiced a lower cost approach to care my whole career. I try to avoid acute hospitalization, medications and procedures in my frail older patients. Why?  Because my experience, as well as a growing body of evidence-based literature, supports this approach. I should be wholeheartedly embracing this new approach to physician incentives. So, why do I feel sick when I think about it?