Introduction: There has been an increase in private equity (PE) involvement in mergers and acquisitions of urology practice in recent years. Little is known about the impact of these acquisitions on quality of care in the years after acquisition. The merit-based incentive payment system (MIPS) is a performance-based payment system implemented by the Centers for Medicare and Medicaid Services (CMS) in 2017 to improve quality and reduce healthcare costs. Its metrics can be leveraged to assess clinical performance in practices acquired by PE. This study investigates the implications of PE mergers and acquisition on MIPS performance. Methods: We conducted a retrospective study of urologist performance in the MIPS database. We focused on years where data would be available before and after a PE acquisition, which were 2018 and 2019. We compared MIPS performance and the probability of receiving a bonus payment between acquired practices to a control group that was oversampled to match the acquired practices’ source of reporting, which is an important predictor of performance. The probability of receiving a bonus payment was calculated based on thresholds reported by CMS. Multivariable regression analysis was performed to assess adjusted MIPS scores and the probability of receiving a bonus payment. Results: In total, there were 6603 urologists who reported to MIPS in 2017. There were 33 total mergers and acquisitions from 2016-2022 (Figure). Compared to nonacquired controls, physicians in acquired practices experienced a decreased adjusted overall MIPS score the year after acquisition (5.2 point difference, p=0.01). The only individual MIPS component score that differed between groups pertained to cost, with slightly higher performance in the nonacquired group (73.2 vs 69.7, p=0.0295). On adjusted analysis, the probability of a bonus payment (Figure) was significantly lower in practices that were acquired vs those that were not acquired in the year after acquisition (50% vs. 73.7%p < 0.001). Conclusions: Private equity acquisition is associated with reduced overall MIPS performance, compared to nonacquired controls. This was associated with significantly reduced probability of a physician receiving a bonus payment. SOURCE OF Funding: This study is supported by funding from National Cancer Institute Advanced Training in Urologic Oncology T32 Grant No T32CA180984 (Faraj) and by funding from the National Cancer Institute RO1 CA269367 (Hollenbeck, Shahinian).
