Association Between Patient Cognitive and Functional Status and Medicare Total Annual Cost of Care

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Abstract
Medicare is moving toward value-based and alternative payment models, in which outpatient clinicians are held accountable for quality and costs of care.1,2 One example is the Merit-Based Incentive Payment System (MIPS), which will adjust outpatient clinicians’ payments up or down by 4% in 2019 based on cost and quality performance.3 Outpatient clinicians covered by MIPS include all physicians, physician assistants, nurse practitioners, and certified nurse specialists who provide care to Medicare beneficiaries and are not already participating in qualified advanced alternative payment models (such as Medicare Accountable Care Organizations).3 As the MIPS start date approaches, there is concern that the program will inappropriately penalize outpatient clinicians for factors beyond their control, and assign penalties and bonuses based on these factors rather than on true differences in clinician performance.1,2,4,5 As a result, the Medicare Payment Advisory Commission recently recommended that Congress repeal MIPS and replace it with a voluntary performance program for outpatient Medicare clinicians.6

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