An analysis of primary care safety-nets' preventive service provision with a new composite reporting measure.

Background: The 2024 Final Rule for physician fee schedule under the Medicare Prospective Centers for Medicare & Medicaid Services (CMS) has sunset and combined seven screening and quality measures for traditional Medicare Merit-Based Incentive Payment System (MIPS) reporting with a single composite clinical quality process measure, Preventive Care and Wellness (PCW). While composites offer benefits including statistical efficiency and increased stability over time, the contextless nature of composite scores may result in disadvantaging low-resource primary care health centers ("health centers") serving medically underserved communities that face healthcare access and outcome challenges.

Objective: Evaluate the CMS composite score metric in health centers to identify characteristics that are associated with higher versus lower composite scores.

Methods: We conducted a 4-year (2019-2022) retrospective data analysis with more than 1.5 million patients from 191 primary care health centers within the OCHIN national network of community health organizations (CHOs). The primary outcome is a modified version of the PCW. Generalized linear mixed models assessed clinic factors associated with score variation, accounting for repeated measures.

Results: Our analysis demonstrated that prepandemic scores started to recover by the end of 2022 (0.6644 vs. 0.6153) and that five factors (pediatric or 65+ patients, Hispanic adults, uninsured patients, and clinic encounter volumes in Q2 and Q4) significantly affected clinic score variation over time.

Conclusions: Our analyses show that preventive service delivery in health centers has nearly recovered from pandemic declines. Differences in subpopulations highlight the importance of context in interpreting health centers' score variation.