Nov, 08 2018

Quality Payment Program (QPP) Year 1 Performance Results

Seema Verma
Administrator, Centers for Medicare & Medicaid Services

Quality Payment Program (QPP) Year 1 Performance Results

Earlier this year, we released preliminary participation data on clinicians eligible to participate in the Merit-based Incentive Payment System (MIPS) under the Quality Payment Program (QPP). This program was a big change for many clinicians, and this year we saw a high participation rate and an emphasis on working to improve outcomes for our beneficiaries.

Since our initial release, we’ve received many requests for additional data to help create a clearer picture of the program’s overall success in its first year. We committed early on to a fully transparent program that provides accurate information. Today, CMS is releasing additional data elements that show significant success in QPP.

I’m pleased to announce that 93 percent of MIPS eligible clinicians received a positive payment adjustment for their performance in 2017, and 95 percent overall avoided a negative payment adjustment. We calculated that 1,057,824 MIPS eligible clinicians* will receive a MIPS payment adjustment, either positive, neutral, or negative. Of that population, 1,006,319 MIPS eligible clinicians reported data as either an individual, as a part of a group, or through an Alternative Payment Model (APM) and received a neutral payment adjustment or better. Additionally, under the Advanced APM track, 99,076 eligible clinicians earned Qualifying APM Participant (QP) status.

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

This chart highlights the percentages of Merit-based Incentive Payment System (MIPS) eligible clinicians who received either a negative, neutral, or positive payment adjustment, as well as an additional adjustment for exceptional performance, for their performance in 2017. It also shows the maximum and minimum MIPS final scores.

These results demonstrate that clinicians who engaged early and meaningfully participated experienced success.

Admittedly, the MIPS positive payment adjustments are modest. It is important to remember that the funds available for positive payment adjustments are limited by the budget neutrality requirements in MIPS, as established by law under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Moreover, 2017 served as a transition year to help ease clinicians into the program and encourage robust participation. The overall performance threshold for MIPS was established at a relatively low level of 3 points, and the availability of “pick your pace” provided participation flexibility through three reporting options for clinicians: “test”, partial year, or full year reporting.

This measured approach allowed more clinicians to successfully participate, which led to many clinicians exceeding the performance threshold and a wider distribution of positive payment adjustments. We expect that the gradual increases in the performance thresholds in future program years will create an evolving distribution of payment adjustments for high performing clinicians who continue to invest in improving quality and outcomes for beneficiaries.  

For clinicians with a negative payment adjustment, we pledge to work with you through our customized technical assistance. You can rely on this no-cost assistance to identify your needs, address potential barriers, and help you prepare to successfully participate in future years. We’re proud that clinicians and practice managers gave our technical support a 99.8 percent customer satisfaction rating.

We’re also devoted to continuing our assistance to solo practitioners and clinicians in small and rural practices through our no-cost Small, Underserved, and Rural Support initiative. Through this effort, we generate awareness of program requirements, assist clinicians with selecting appropriate measures, and help these clinicians improve with each performance year.

From a scoring perspective, the overall national mean (or average) score for MIPS eligible clinicians was 74.01 points, and the national median was 88.97 points. To further breakdown the national mean and median:

  • Clinicians participating in MIPS as individuals or groups (and not through an APM) received a mean score of 65.71 points and a median score of 83.04 points
  • Clinicians participating in MIPS through an Alternative Payment Model (APM) received a mean score of 87.64 points and a median score of 91.67 points

Additionally, clinicians in small and rural practices who were not in APMs and who chose to participate in MIPS also performed well. On average, MIPS eligible clinicians in rural practices earned a mean score of 63.08 points, while clinicians in small practices received a mean score of 43.46 points. While we understand that challenges remain for clinicians in small practices, these results suggest that these clinicians and those in rural practices can successfully participate in the program. With these mean scores, clinicians in small and rural practices would still receive a neutral or positive payment adjustment for the 2017, 2018, and 2019 performance years due to the relatively modest performance thresholds that we have established. We will also continue to directly support these clinicians now and in future years of the program.

These are significant strides and we know that more work remains. While MIPS is required under law, I'm making a personal commitment to further reduce burdensome requirements and will work with you to make that a reality. Our obligation is to make this a practical program for every clinician, in both small and large practices. We take this responsibility very seriously. We’re committed to continue leveraging our Patients over Paperwork framework to review many of the MIPS requirements to reduce burden and add additional flexibilities so clinicians can successfully participate without sacrificing the time they spend with patients.

We’re still listening and looking for ways to improve the Quality Payment Program to help drive value, reduce burden, promote meaningful participation by clinicians, and improve outcomes for beneficiaries. We’ll continue to analyze the data from the 2017 performance year and share additional elements. We encourage clinicians, stakeholders, and others to send us their feedback to help identify areas of immediate need as well as shape the program for future performance years.

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* Clinicians are identified under the Quality Payment Program by their unique Taxpayer Identification Number/National Provider Identifier combination (TIN/NPI).