Impact of MACRA Legislation and MIPS Scores on Value Analysis for Negative Pressure Wound Therapy Devices

Introduction: The Medicare Access and CHIP Reauthorization Act (MACRA) changes clinician reimbursement from a fee-for-service payment system to a fee-for-value system. Physicians are scored according to the quality of care in a Merit-based Incentive Payment System (MIPS) and receive a positive or negative modifier, which directly impacts Medicare reimbursement.

Objective: This study analyzes how different negative pressure wound therapy (NPWT) devices affect MIPS scoring.

Methods: Based on a literature review of cost-effectiveness and end-user assessments for NPWT, the categories of Quality, Resource Use, and Clinical Practice Improvement Activities (CPIA) were scored using a relative value measure scale for their impact on the overall MIPS score. The MIPS category of Advancing Care Information and Participation in Alternative Payment Models were not analyzed as part of this study. Using this scale, devices from 2 major NPWT manufacturers were compared for the impact on MIPS scoring in 3 different wound categories: complex wounds requiring inpatient care (NPWT-A vs. NPWT-B), heavily exudating wounds treated in outpatient care (NPWT-C vs. NPWT-D), and low-exudating wounds treated in outpatient care (NPWT-E vs. NPWT-F).

Results: For complex wounds requiring inpatient care, NPWT-A scored better than NPWT- B in the categories of Quality, Resource Use, and CPIA. For highly exudating wounds treated via outpatient care, NPWT-C scored better than NPWT-D in the category of Quality; however, NPWT-C and NPWT-D scored similarly in the categories of Resource Use and CPIA. For low-exudating wounds treated on an outpatient basis, the NPWT-E device scored higher in the categories of Quality and Resource Use, whereas the 2 devices scored similarly in the category of CPIA.

Conclusions: Results from this study suggest that NPWT device selection can differentially impact the MIPS score. Furthermore, a positive MIPS score and a positive modifier for Medicare reimbursement are attainable by selecting more cost-effective and patient satisfactory treatments in daily practice.