Project Title: Can the Medicare Quality Payment Program Incentivize Evidence-Based Treatment of Depression and Anxiety Disorders by Primary Care Providers?
Project Summary: Depression and anxiety disorders are common in patients in the primary care setting and have clear evidence-based guidelines for screening, diagnosis, and treatment. However, rates of screening and treatment among Medicare beneficiaries remain low. Without proper treatment, these patients may experience persistent depression and anxiety symptoms, difficulty co-managing other conditions, worsening functional status, and avoidable and expensive acute medical events. In 2017, Medicare launched the Quality Payment Program (QPP) to incentivize delivery of high quality, low cost, evidence-based care in the outpatient setting. Primary care providers (PCPs) are required to participate in the QPP via one of two tracks: 1) the Merit-Based Incentive Payment System (MIPS), the default track; or 2) alternative payment models (APMs) such as accountable care organizations (ACOs) and patient-centered medical homes (PCMHs). In the both the APMs and MIPS, PCPs are paid for their performance based on the quality and cost of care they deliver to patients. However, the effects of these QPP models on treatment of depression and anxiety disorders by PCPs are unknown.
The objective of this project is to conduct a longitudinal study linking rich national datasets of Medicare claims, patient surveys, and PCP data to evaluate: 1) patient and PCP risk selection into the APMs vs. MIPS; 2) whether financial incentives to PCPs in the QPP contribute to this risk selection and how they may be remedied; and 3) the effect of patient care from PCPs in the APMs vs. MIPS on delivery of evidence-based treatment for depression and anxiety disorders and subsequent patient outcomes.
Funding Organization: National Institute of Mental Health (NIMH)
Project Start Date: September 7, 2021
Project End Date: Ongoing
Principal Investigator: Kenton J. Johnston
Co-investigators: Hefei Wen, Benjamin Druss, Jason Hockenberry, Travis Loux
Publications:
- Qi AC, Joynt Maddox KE, Bierut LJ, Johnston KJ. Comparison of performance of psychiatrists vs other outpatient physicians in the 2020 US Medicare Merit-based Incentive Payment System. JAMA Health Forum. 2022;3(3): e220212. doi: 10.1001/jamahealthforum.2022.0212. PMID: 35977292; PMCID: PMC8956979.