Number of clinicians, success in Quality Payment Program increase

Clinician participation rates and success in the Quality Payment Program continue to rise, according to the Centers for Medicare and Medicaid Services, which reported new data on the QPP’s second year.

Participation rates and success in QPP increased from 2017 to 2018, reports CMS, with improvements in both program tracks—Advanced Alternative Payment Models (APMs) and the Merit-based Incentive Payment System (MIPS).

QPP was launched in 2017 to provide a framework in which clinicians are challenged to lower costs and increase the quality of care they provide to patients.

Writing in a blog, CMS Administrator Seema Verma revealed that qualifying APM participants in Advanced APMs nearly doubled in 2018 from the previous year, increasing from 99,076 to 183,306 clinicians.

Verma also noted that the number of clinicians participating in MIPS through APMs increased from 341,220 participants in 2017 to 356,828 in 2018.

“These participation improvements may be related to the increasing number of participation opportunities in 2018, particularly through Accountable Care Organizations (ACOs) in the Shared Savings Program,” wrote Verma.

“I am excited about this progress, as it is a critical indicator (that) we are succeeding in our goal of maximizing participation in MIPS APMs and Advanced APMs,” she added. “This increase in APM participation supports the evolution of the program and incentives towards a system of value that puts patients first.”

Verma-Seema-CROP.jpg
Seema Verma, Centers for Medicare and Medicaid Services administrator nominee for U.S. President Donald Trump, speaks during a Senate Finance Committee confirmation hearing in Washington, D.C., U.S., on Thursday, Feb. 16, 2017. Verma, the businesswoman Trump selected to oversee Medicaid, the health care program for 74 million low-income Americans, has said the program is structurally flawed by policies that burden states and foster dependency among the poor. Photographer: Pete Marovich/Bloomberg

Also See: CMS Quality Payment Program exceeds first year participation goal

When it comes to clinician success in MIPS, Verma reported that 97 percent exceeded the performance threshold score of 15 points to receive a positive payment adjustment based on performance in 2018—an increase from 93 percent in 2017, when clinicians needed to exceed a performance threshold of just three points to receive a positive payment adjustment.

“Scores improved across performance categories, with the biggest gain in the Quality performance category, which highlights the program’s effectiveness in measuring outcomes for beneficiaries,” according to Verma. “MIPS final scores increased across all practice sizes and types of participation (individual, group and for clinicians participating in MIPS through an APM).”

CMS also reported other gains in the QPP. For example, last year 98 percent of eligible clinicians participated in MIPS, up from 95 percent in 2017. Further, almost 90 percent of clinicians in small practices participated in 2018, an increase from 81 percent in 2017.

“Primary flexibilities introduced in the Physician Fee Schedule rule for the 2018 performance year were increases in the Medicare patient count and Medicare Part B allowed charges required to participate in MIPS, which meant that fewer clinicians in small practices were required to participate, but results show they elected to do so anyway,” according to Verma.

She also reported that small practices scored much better in 2018 than 2017, with nearly 85 percent surpassing the scoring threshold for a positive payment adjustment, up from nearly 74 percent in 2017.

“While we are proud of program successes, our goal has always been to develop a meaningful Quality Payment Program for every clinician, regardless of practice size or specialty, and we recognize that additional long-term improvements are needed,” Verma concluded.

In particular, she pointed out that “some clinicians in small practices are still receiving negative payment adjustments” and acknowledged that CMS has “heard from clinicians and stakeholders that the program, specifically MIPS, remains overly complex due to the use of broad clinician flexibility.”

As a result, Verma pledged to “continue to leverage initiatives like Patients Over Paperwork and Meaningful Measures to address concerns and look for possible solutions.”

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