The Centers for Medicare & Medicaid Services (CMS) is deeply committed to ongoing data transparency and creating a patient-centered healthcare system, where clinicians are challenged to lower costs and increase the quality of care they provide. At the same time, we want to empower patients to make more informed healthcare decisions by providing meaningful information about their healthcare providers. The Quality Payment Program (QPP) is a key component of these efforts. Launched in 2017, QPP provides a framework to improve care delivery by supporting and rewarding clinicians as they find new ways to engage patients, families, and caregivers, while improving care coordination and population health management. Keeping with our commitment to data transparency we are excited to announce that 2017 QPP performance information is now available on the Physician Compare website to help patients find and compare Medicare clinicians in order to make informed healthcare decisions. I’m also pleased to share that clinician participation rates and success in QPP increased from 2017 to 2018. These improvements spanned both program tracks—Advanced Alternative Payment Models (APMs) and the Merit-based Incentive Payment System (MIPS).
Ongoing Data Transparency
The Physician Compare website allows Medicare patients and caregivers to search for and compare clinicians and groups who are enrolled in Medicare. The overarching goals of Physician Compare are, 1) to help people with Medicare make informed health care decisions and, 2) to incentivize clinicians and groups to maximize their performance. Publicly reporting 2017 QPP performance information will help further those goals.
As part of CMS’s continued phased approach to public reporting on Physician Compare, CMS is publicly reporting a subset of the 2017 QPP information submitted under MIPS and APMs. The information added on profile pages for MIPS eligible clinicians and groups includes:
- 12 MIPS quality measures reported by groups and displayed as measure-level star ratings on group profile pages;
- 8 Consumer Assessment for Healthcare Provider and Systems (CAHPS) for MIPS summary survey measures displayed as top-box percent performance scores on group profile pages;
- 6 Qualified Clinical Data Registry (QCDR) quality measures reported by groups and displayed as percent performance scores on group profile pages;
- 11 QCDR quality measures reported by individual clinicians and displayed as percent performance scores on individual clinician profile pages.
CMS will remain committed to sharing important data with clinicians and their patients as it becomes available so that together they can make the best healthcare decisions possible.
Increasing Value in 2018
The number of QPs—Qualifying APM Participants in Advanced APMs—nearly doubled in 2018 from the previous year, increasing from 99,076 to 183,306 clinicians QPs receive a five percent APM incentive payment and are excluded from the MIPS reporting requirements and payment adjustment. The number of clinicians participating in MIPS through APMs also 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. I am excited about this progress, as it is a critical indicator we are succeeding in our goal of maximizing participation in MIPS APMs and Advanced APMs. This increase in APM participation supports the evolution of the program and incentives towards a system of value that puts patients first.
Flexibilities we introduced led to 98% of eligible clinicians participating in MIPS in 2018, up from 95% in 2017. Additionally, nearly 90% of clinicians in small practices participated in 2018, which was an increase from 81% 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.
Clinician success in MIPS has continued to rise with 97% exceeding the performance threshold score of 15 points to receive a positive payment adjustment based on performance in 2018. This is an increase from 93% in 2017, when clinicians needed to exceed a performance threshold of just 3 points to receive a positive payment adjustment—a strong sign that our incremental approach and flexible options lead to clinician success in MIPS.
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.
MIPS final scores increased across all practice sizes and types of participation (individual, group, and for clinicians participating in MIPS through an APM). I am delighted to report that small practices—with additional flexibilities and continued support from the Small, Underserved, and Rural Support initiative—scored much better in 2018 than 2017. Nearly 85% surpassed the scoring threshold for a positive payment adjustment, up from nearly 74% in 2017
Our new infographic provides more highlights and preliminary data on Quality Payment Program participation and performance in 2018.
These successes are a testament to the combined efforts of clinicians, stakeholders, our no-cost technical assistance organizations, and CMS to make MIPS better—especially by providing clinicians with measures and activities that are more relevant to how they care for their patients. We used our Meaningful Measures framework to remove low-value process measures and focus on patient outcome measures that will improve care.
We also leveraged our Patients over Paperwork initiative to review MIPS, removing unnecessary elements to help streamline program requirements and further reduce clinician burden.
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.
Some clinicians in small practices are still receiving negative payment adjustments. And we have heard from clinicians and stakeholders that the program, specifically MIPS, remains overly complex due to the use of broad clinician flexibility.
We take this feedback to heart and will continue to leverage initiatives like Patients Over Paperwork and Meaningful Measures to address concerns and look for possible solutions.
I look forward to sharing more news on the steps we are taking to transform MIPS in the coming days. As always, we’ll work hand-in-hand with clinicians and stakeholder groups in continuing to drive MIPS toward enhanced value.
I’d like to extend gratitude to all the stakeholder groups and clinicians who have shared their feedback and ideas with us to date. We look forward to continuing to work with you on innovative value-based approaches to ensure patients are at the center of care.