Value-Based Care News

MIPS Participation Reached 95% in 2017, Exceeding CMS Goals

MIPS participation exceeded the goal of 90 percent of eligible clinicians in 2017, and more than 29,000 more clinicians joined an Advanced APM than CMS expected.

Eligible clinicians and MIPS participation

Source: Thinkstock

By Jacqueline LaPointe

- Ninety-five percent of eligible clinicians avoided a negative payment adjustment through Merit-Based Incentive Payment System (MIPS) participation in 2017, of which 93 percent earned a positive adjustment.

The findings come from the 2017 Quality Payment Program Reporting Experience report recently published by CMS. The report provides a comprehensive view of the clinician experience in the first performance year of the Quality Payment Program, which includes MIPS and the Advanced Alternative Payment Model (Advanced APM) track.

The report shows CMS exceeded Quality Payment Program participation goals and clinicians benefited from partaking in the new value-based reimbursement program.

The federal agency aimed to have 90 percent of eligible clinicians participate in MIPS in 2017, which had flexible participation options to help ease providers into the new program and promote robust participation.

The data indicates the “Pick Your Pace” approach worked, with over 90 percent of eligible clinicians participating in MIPS and 99,076 providers considered qualifying APM participants (QPs) under the Advanced APM track. CMS only anticipated about 70,000 eligible clinicians to reach QP status in 2017.

READ MORE: Exploring Changes to the Quality Payment Program in 2019

In the report, CMS points out that exceeding the Advanced APM participation goal is a point of pride for the agency.

“The Advanced APM track offers a five percent incentive for significant participation in an Advanced APM and rewards clinicians for taking on greater risk and accountability for patient outcomes,” the agency writes. “While both tracks are structured to complement each other, one of CMS’s foremost goals under the Quality Payment Program is to encourage the movement of clinicians and practices into APMs or Advanced APMs and ultimately toward a value-based system.”

CMS also boasts that most eligible clinicians elected to submit data beyond the minimum requirements despite flexible participation options under “Pick Your Pace.”

In 2017, eligible clinicians only had to earn three points as their MIPS final score to avoid a negative payment adjustment in the 2019 payment year. That means clinicians only had to submit a small amount of data on one quality measure, one Improvement Activity, or the base measures for the Advancing Care Information performance category.

Eligible clinicians also had the option to submit data for a 90-day period to earn a modest payment adjustment or submit data for a full year to qualify for the maximum payment adjustment in 2019.

READ MORE: Key Ways to Succeed Under MACRA’s Quality Payment Program

Eligible clinicians who reported to MIPS and not the Advanced APM track generally reported data for 90 days or longer. Only about one-quarter of MIPS eligible clinicians submitted data for less than 90 days.

Chart shows that three-quarters of eligible clinicians opted to report more than 90 days of data to the Merit-Based Incentive Payment System (MIPS).

Source: CMS

Even small and rural practices, which face unique challenges with MIPS implementation, opted to submit more than the minimum amount of data in 2017, the report states.

Meaningfully participation in MIPS benefited clinicians financially. The overwhelming majority of eligible clinicians earned a positive payment adjustment based on their 2017 MIPS performance, and just five percent earned a negative adjustment.

Additionally, 93 percent of MIPS eligible clinicians in rural practices and 74 percent of MIPS eligible clinicians in small practices will receive a positive adjustment.

The highest payment adjustment applied in the 2019 payment year is 1.88 percent, CMS reports. Clinicians seeing the maximum adjustment earned top MIPS performance marks (100 points) and achieved the additional adjustment for exceptional performance.

Chart shows 93 percent of MIPS eligible clinicians earned a positive payment adjustment based on their 2017 performance.

Source: CMS

READ MORE: Developing a 2018 MIPS Reporting Strategy to Avoid a Penalty

The maximum payment adjustment is 0.20 percent for eligible clinicians who did not achieve exceptional performance status by earning between 3.01 to 69.99 points as a final MIPS score.

The financial rewards of participating in MIPS in 2017 pale in comparison to the payment adjustments detailed in the original MACRA implementation rule. Policymakers intended the maximum positive payment adjustment for the 2019 payment year to be four percent.

However, the “Pick Your Pace” approach to MIPS participation modified the original MACRA implementation plan for the first performance year, and the program is subject to budget neutrality. As a result, positive payment adjustments are modest in comparison to those under full implementation.

Industry groups have criticized CMS for allowing flexible participation options knowing the payment adjustments would be less than originally intended.

“These insignificant payment updates fail to reward providers for superior performance in the MIPS program and provides nominal return on investments,” AMGA recently argued. “Unfortunately, MIPS has devolved into an expensive regulatory compliance exercise with little to no impact on quality or cost. Policymakers should no longer exclude providers from MIPS.”

CMS intends to increase payment adjustment thresholds as the agency continues to implement the Quality Payment Program. For example, CMS predicts MIPS positive adjustments to equal $118 million in the 2020 payment year, with an additional $500 million for exceptional performance.

“While we’ve made significant process, we know additional work remains. We’re making a strong commitment to further reduce burdensome requirements and will work with clinicians and practices to make that a reality,” the federal agency concludes in the report.

“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.””