Urology Practice recently published a study that found that urologists in practices that have been acquired by private equity firms had lower scores on the Medicare Merit-based Incentive Payment System (MIPS) when compared to those in practices not acquired by private equity firms.
The study compared MIPS scores during the years 2017 to 2020 for 181 urologists, specifically looking at the years prior to and after the practice was acquired by a private equity firm. These MIPS scores were then compared to scores from 2368 urologists whose practices were not acquired during the period, for a total sample of 2,549 urologists.
In the year prior to private equity acquisition, acquired urologists demonstrated MIPS scores similar to non-acquired urologists, with an overall MIPS score of 89 among acquired urologists and 90 among non-acquired urologists. When broken down further to look at MIPS component scores, the findings were consistent with similar scores in quality, improvement activities, and promoting interoperability. When the likelihood of receiving bonus payments was reviewed, it too was similar between the groups, with 92% of acquired urologists receiving a bonus compared to 90% of non-acquired urologists.
However, turning to the year after the acquisition, urologists in acquired practices had worse overall MIPS scores (75 compared to 86) and quality scores (73 compared to 89) when compared to non-acquired urologists. The urologists in acquired practices were also less likely to receive a bonus payment when compared to their non-acquired colleagues, 35% compared to 72%. The study found no significant score differences in improvement activities or promoting interoperability between the two groups of urologists.
The study then used a difference-in-differences framework to assess the relationship between practice acquisition and outcomes. Acquisition was associated with a 14-point reduction in overall MIPS scores for the acquired urologists, with the difference largely driven by significantly lower scores in the quality category. Acquired urologists also had lower cost scores when compared to the non-acquired urologists, but cause and effect is hard to correlate as it was based on only two years of data available for the study. As indicated above, acquisition was also associated with a significant reduction in bonus payments to urologists at acquired practices when compared to their non-acquired colleagues.
The study authors concluded, “As private equity firms increasingly engage in urology, key stakeholders, including policymakers and urologists, need to ensure that the quality of care is not compromised with the structural changes implemented after acquisition…. While further regulation in this space may be impractical, until more research is done to determine the effect of these acquisitions on patient care, it is important for practices to be transparent about their relationship with for-profit entities with patients and referring providers.”