Ideally, incentives should be structured as a pure bonus (5% to 20% of total historical cash compensation or the amount of compensation that was received in the previous year), meaning the original components of compensation remain the same, and high performance in quality metrics results in incremental compensation. In negotiations, if decision-makers are amenable to a pure bonus structure, metric targets will likely need to be set so that achievement represents status quo performance or better.

Alternatively, incentives can be structured as both at risk and a bonus (again, 5% to 20% of total historic cash compensation), with status quo performance resulting in original compensation or higher.

E. Metrics for ID 1. Overview of Measures Capturing ID physicians’ efforts to improve the coordination of care and ensure the correct care pathways has been shown to increase performance within existing value-based arrangements. With ID especially, capitalizing on infection protocol-related activities to reduce health care-associated infections and readmission rates has proven to have a meaningful impact on the success of value-based arrangements. Merit-Based Incentive Payment System metrics are a frequent place to start when incorporating quality and value into risk-based arrangements. The below metrics are intended to be ID focused and specific and fairly universal across practice settings for implementation.

2. Merit-Based Incentive Payment System MIPS is a program that determines Medicare payment adjustments based on a composite of four performance scores (i.e., quality, cost, improvement activities and promoting interoperability). The final score determines if a Medicare payment adjustment will occur to the claim.

There are additional actions outlined by MIPS legislation that are related to ID physician activities and have a direct impact on value-based reimbursement. These activities include collecting and using patient experience and satisfaction data, engaging and following up with new Medicaid patients, improving documentation processes and providing more timely communication of test results. Existing measures that are defined within the 2023 MIPS that are designated for ID physicians (though some are less specific) include but are not limited to: • Preventive Care and Screening: Influenza Immunization; • Documentation of Current Medications in the Medical Record; • Pneumococcal Vaccination Status for Older Adults; • HIV/AIDS: Sexually Transmitted Disease Screening for Chlamydia, Gonorrhea and Syphilis; • HIV Viral Load Suppression; • HIV Medical Visit Frequency.