Oct 27, 2020

2019 Quality Payment Program (QPP) Performance Results

Seema Verma
Administrator, Centers for Medicare & Medicaid Services

At the Centers for Medicare & Medicaid Services (CMS), our number one priority continues to be getting patients the care they need as we confront the unprecedented COVID-19 pandemic. We are committed to reducing clinicians’ administrative burden related to the Quality Payment Program, so clinicians can focus on patient care during this public health emergency.

Flexibilities

We took swift action to offer flexibilities for the Quality Payment Program for the 2019 performance year, to ease clinicians’ reporting burden during early 2020. These changes in response to the COVID-19 Public Health Emergency (PHE) included:

  • Extending the submission window for the Merit-based Incentive Payment System (MIPS) through April 30, 2020.
  • Extending the automatic Extreme and Uncontrollable Circumstances policy to all individual MIPS eligible clinicians for the 2019 performance year who had not submitted data to CMS.
  • Re-opening the 2019 Extreme and Uncontrollable Circumstances application to allow clinicians, groups, and virtual groups to request reweighting of the MIPS performance categories to 0%.

We were very encouraged to see that with these flexibilities in place, clinicians overwhelmingly engaged in the Quality Payment Program, despite the challenges caused by the pandemic.

Participation Rates

More than 97% of MIPS eligible clinicians engaged with the program by submitting some data at the individual, group, virtual group, or Alternative Payment Model (APM) Entity level for 2019.

Let’s take a closer look at the preliminary 2019 participation results:

Overall Participation

  • 538,323 eligible clinicians participated in MIPS as individuals or groups.
  • 416,281 eligible clinicians participated in MIPS through APMs.

Small Practice Participation

  • 85.22% of MIPS eligible clinicians in small practices were engaged in the Quality Payment Program.
  • The average (mean) score for small practices increased from 65.69 in 2018 to 68.99 in 2019.

Advanced APM Participation

  • The total number of Qualifying APM Participants (QPs) increased from 183,306 in 2018 to 195,564 in 2019.

COVID-19 Impact

  • 65,237 (6.83%) of MIPS eligible clinicians received reweighting of one or more MIPS performance categories due to our MIPS Extreme and Uncontrollable Circumstances policy.
  • Of those clinicians, 29,136 received reweighting of all their performance categories and were assigned a neutral score.

Payment Adjustments

Shows percentages of participating clinicians

We’re pleased to share that the maximum MIPS payment adjustment for exceptional performance during the 2019 reporting year will be the highest since the program began. Clinicians with a final score equal to or above 75.00 points will receive a positive payment adjustment in 2021 of up to 1.79%. Congress set up a funding stream for exceptional performance for the program’s first 6 years for top MIPS performers.

Some other clinicians, however, may see lower than expected positive payment adjustments. This is because the Quality Payment Program is required by law to be budget neutral, and more clinicians who may have faced maximum negative adjustments qualified for reporting exceptions under the MIPS Extreme and Uncontrollable Circumstances policy. As a result, there is a smaller pool of dollars from negative payment adjustments that can be redistributed and used for the positive payment adjustments. Though this may be disappointing, it’s critical that we support every clinician so they can focus on what’s most important during the COVID-19 pandemic, caring for patients.

Some may question whether participating in the Quality Payment Program has been worth the investment given lower positive payment adjustments. But we urge clinicians to continue on this journey to value-based care with us. We believe the benefits of this program will be realized as we continue to reduce reporting burden, make participation more meaningful to patient care, and empower patients with critical data.

Future of the Quality Payment Program

We’re always listening and looking for ways to advance the Quality Payment Program to help drive value for all Americans while reducing clinician burden, offering meaningful ways to participate, and improving outcomes for patients. Therefore, the Quality Payment Program will continue evolving over the next several years to achieve these goals.

Since we introduced MIPS Value Pathways, or MVPs, in the 2020 Physician Fee Schedule final rule, we have been collaborating with stakeholder groups on the development of MVPs. MVPs are part of CMS’s shift from siloed activities and measures to an aligned set of measure options specific to a clinician’s scope of practice and patient care. MVPs will improve patient care and also create more comparative performance data that will help patients and caregivers evaluate clinician performance and make choices about their care. Input from clinicians, medical societies and health care trade associations is critical to ensuring MVPs are meaningful to clinicians and how they practice and to the overall success of MIPS and the Quality Payment Program. We look forward to continuing our work with these stakeholder groups as we look to launch MVPs in 2022, as currently proposed.

We are also proposing to create a new optional reporting and scoring pathway for MIPS eligible clinicians who participate in MIPS APMs: the APM Performance Pathway (APP). Complementary to MVPs, the APP is a single, pre-determined measure set that MIPS APM participants may report beginning with the 2021 performance year. It’s designed to provide reliable and consistent MIPS reporting requirements to reduce burden and encourage participation in APMs.

While we continue to transform the Quality Payment Program through MVPs, the APP, and other policy changes and proposals, we’ll also continue to implement flexibilities to the current MIPS and APM tracks of the program to ensure clinicians can continue to focus on their patients during this unprecedented time. More information about 2020 program changes is available on the QPP website.

We thank all clinicians and their staff for their continued dedication and tireless efforts to combat COVID-19 within our communities while caring for patients.

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