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What is the benefit of risk adjustment to providers?

  • In today's performance-based payment models, such as the Merit-based Incentive Payment Program (MIPS), providers' payments are closely tied to their patients' health outcomes. Providers can't (ethically) choose their patients, however. Without risk adjustment, providers in disproportionately higher-risk populated areas would receive payment reductions that may not reflect accurately the quality of care they provide. Risk adjustment allows for more accurate comparisons across provider Tax Identification Numbers by removing differences in health and other risk factors that affect measured outcomes not under the provider's control.

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