Jan 06, 2020

2018 Quality Payment Program (QPP) Performance Results

Seema Verma
Administrator, Centers for Medicare & Medicaid Services

2018 Quality Payment Program (QPP) Performance Results

In 2015, Congress passed the Medicare Access and CHIP Reauthorization Act – or MACRA. In an attempt to streamline multiple quality programs for physicians, the law created the Merit Based Incentive Payments System (MIPS). Unfortunately, upon implementation of the law, many clinician stakeholders still found the system confusing and burdensome.

Shortly after President Trump took office, we began taking a close look at ways to cut government red tape. At CMS, this effort is called Patients Over Paperwork (PoP). Through PoP, we’ve sought clinician input through requests for information, listening sessions, and interviews, and we’ve asked them to tell us ways we can get rid of the needless, duplicative paperwork that keeps them from caring for their patients. We’ve received incredible feedback.

Through PoP and a related initiative called Meaningful Measures, we’ve focused on improving quality measurement for doctors. This year, we were excited to finalize our MIPS Value Pathways (MVPs) proposal in our 2020 Physician Fee Schedule final rule that would transform the MIPS program into one that engages clinicians and specialty societies, to craft measures that assess them on what matters most – outcomes.

While our MVP framework becomes effective in 2021, we’re still committed to implementing the current version of MIPS. To that end, earlier this year, we released preliminary participation data for clinicians eligible to participate in MIPS. We are pleased to announce that our participation rates for 2018 exceeded our participation rates in 2017, the first year of the program. We now have additional performance results for the MIPS 2018 performance year and we are excited to share them with you.

For the 2018 performance year:

  • 98 percent of eligible clinicians participating in MIPS will receive a positive payment adjustment in 2020.
    • What This Means: More clinicians will receive positive payment adjustments. This is a 5 point increase over the 2017 performance year — and that’s with an overall positive performance threshold for MIPS increase from 3 points in 2017 to 15 points in 2018.
       
  • 97 percent of eligible clinicians in rural practices will receive a positive payment adjustment, compared to 93 percent in 2017. For small practices, 84 percent of eligible clinicians received a positive payment adjustment, an increase from 74 percent in 2017.
    • What This Means: More rural and small practices will receive positive payment adjustments. This shows we are making strides towards making MIPS a practical program for every clinician, regardless of size.
       
  • 889,995 clinicians received a MIPS payment adjustment, either positive, neutral, or negative. Out of that population, 872,148 MIPS eligible clinicians will receive a neutral payment adjustment or better through their individual, group or Alternative Payment Model (APM) participation.
    • What This Means: More clinicians (98 percent) earned a neutral or positive payment adjustment in 2018, which is an increase from 95 percent in 2017. 98 percent of clinicians avoided a negative payment adjustment, compared to 95 percent from last year. From a scoring perspective, the overall national mean (or average) and median scores increased from 2017. Clinicians who specifically participated in MIPS through an APM had a mean score of 98.77 and a median score of 100.
       
  • 183,306 eligible clinicians earned Qualifying APM Participant (QP) status under the Advanced APM path while another 47 eligible clinicians received partial QP status during 2018.
    • What This Means: More clinicians are earning QP status. In 2017, the number of eligible clinicians who met QP status was 99,076 and partial QP status was 52. The increase in Advanced APM participation in 2018 reflects an increase in clinicians who provide high quality and cost-efficient care while moving towards value-based payments through Advanced APM participation.

We will continue to strengthen program policies that reward the high-quality treatment of patients and increase opportunities for APM participation.

The chart below highlights some of the additional payment adjustment breakouts.

The chart below highlights some of the additional payment adjustment breakouts.

Positive payment adjustment will remain modest in part because, under the MACRA law, the positive and negative payment adjustments must be budget neutral. This means that the funds available for positive payment adjustments are limited to the estimated decrease in payments resulting from the negative payment adjustments. But because the thresholds have been lower, many providers have qualified. As the program matures, we expect that the increases in the performance thresholds in future program years will create a smaller distribution of positive payment adjustments for high performing clinicians who continue to invest in improving quality and outcomes for beneficiaries and positive adjustments will increase. However, it’s also important to note that Congress provided $500 million for the first six years of the law to fund additional adjustments for exceptional performance. These adjustments are not budget neutral, allowing exceptional performers to achieve higher positive adjustments.

Although the results are encouraging, there are clinicians who will receive negative payment adjustments. We are committed to supporting these clinicians to reduce reporting complexity and burden, encourage meaningful participation, and improve patient outcomes. We are also fully committed to providing technical assistance to solo practitioners, small practices and clinicians in rural areas through our no-cost Small, Underserved, and Rural Support initiative. Through this effort, we are able to generate awareness of program requirements, assist clinicians with selecting appropriate measures, and help clinicians improve with each performance year.

Our goal is to make sure that our program and all CMS programs support clinicians in their critical role, regardless of practice size or specialty. We have leveraged our PoP initiative to review the existing program elements to help streamline the program requirements and reduce clinician burden so that clinicians can focus on spending time with patients and delivering high-quality care. We have also reduced the number of MIPS quality measures through our Meaningful Measures framework to remove low-bar, standard of care, process measures and focus on outcome and high-priority measures that will improve care for patients.

In closing, CMS is committed to supporting clinicians in the important work they do. Our work through PoP and Meaningful Measures to address issues in MIPS – and our work on the MVPs are just some of the ways we’re making good on that commitment; we’re keenly focused on reducing burden and making it easier for doctors to do their jobs. Our 2019 final Physician Fee Schedule rule, for example, overhauled evaluation and management (E&M) codes for the first time in over two decades. In that effort, we worked closely with the physician community to ensure doctors’ voices were heard. The result is a system that allows clinicians to focus on patients, not paperwork. We are excited for what the future holds for the Quality Payment Program and our collaboration with each of you to ensure we continue to get your feedback while we develop our MVPs framework. We are always listening and looking for ways to improve the Quality Payment Program to help drive value, reduce burden, promote meaningful participation by clinicians, and improve patient outcomes.

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