Advanced APM Participation Almost Doubled from 2017 to 2018

July 16, 2019 - Advanced Alternative Payment Model (APM) participation in the Quality Payment Program (QPP) nearly doubled from 2017 to 2018, increasing from 99,076 to 183,306 clinicians, CMS recently reported in an official blog post.

Participation in APMs through QPP’s other track – the Merit-Based Incentive Payment System (MIPS) – also grew in 2018, increasing from 341,200 eligible clinicians in 2017 to 356,828 in 2018, the federal agency reported.

“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,” CMS Administrator Seema Verma stated in the blog post. “This increase in APM participation supports the evolution of the program and incentives towards a system of value that puts patients first.”

A major goal for QPP implementation is to move clinicians to APMs that hold providers financially and clinically accountable for the care they deliver to patients. To incentivize participation in such models, MACRA implementation rules state that eligible clinicians do not have to participate in MIPS and they can earn a five percent bonus by joining an approved APM.

Advanced APM participation rates exceeded CMS goals for the first QPP performance year, according to the 2017 Quality Payment Program Reporting Experience report recently published by CMS. The federal agency only expected about 70,000 eligible clinicians to participate in the models in 2017.

READ MORE: Understanding the Quality Payment Program’s Advanced APM Track

Eligible clinicians continue to surpass CMS expectations for QPP, updated participation rates showed. Even participation in MIPS increased from 2017 to 2018, the blog post stated.

CMS reported that 98 percent of eligible clinicians participated in MIPS in 2018, up from 95 percent in 2017. However, the actual number of eligible clinicians participating in the program fell because of flexibilities granted to clinicians by CMS. Overall, 916,058 clinicians received a MIPS payment adjustment in 2018, which is down from over 1 million clinicians in 2017.

Additionally, the number of clinicians in small practices participating in MIPS during the period also increased, rising from 81 percent in 2017 to almost 90 percent in 2018, CMS reported.

Participation flexibilities, including increases in the Medicare patient count and Medicare Part B allowed charges thresholds, impacted MIPS participation, CMS explained.

The flexibilities provided in the final rule for MACRA implementation in 2018 meant that fewer clinicians, especially those in small practices, had to participate in MIPS that year. Industry leaders, including AMGA, stated that the rule excluded more than one-half of clinicians from MIPS, leading to lackluster financial rewards for those who had to participate because QPP is budget-neutral.

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

But CMS recently reported that clinicians elected to participate in MIPS despite increased participation flexibilities. And the clinicians realized the benefits of MIPS participation in 2018.

About 97 percent of eligible clinicians in MIPS exceeded the performance threshold of 15 points, which was a substantial increase from three points the previous performance period. The number of clinicians qualifying to earn a positive MIPS payment adjustment based on performance increased from 93 percent in 2017.

Verma pointed out that the statistic is “a strong sign that our incremental approach and flexible options lead to clinician success in MIPS.”

CMS also saw MIPS performance scores increase, with the largest gain in the Quality performance category. Additionally, MIPS final scores rose for all practice sizes and types of participation (i.e., individual, group, and clinicians participating in MIPS through an APM), the blog post stated.

In particular, small practices scored higher in 2018 versus 2017, with nearly 85 percent surpassing the scoring threshold for a positive MIPS payment adjustment. Only about one-quarter (74 percent) of small practices achieved that in 2017.

READ MORE: How Can CMS Improve MACRA’s Quality Payment Program, MIPS?

“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,” Verma stated.

She highlighted the efforts of the Meaningful Measures framework, which removed low-value process measures from QPP, and the Patients Over Paperwork, an agency-wide initiative that reviewed MIPS and eliminated unnecessary elements to streamline program requirements and decrease clinician burden.

Looking forward, CMS plans to build on 2018 QPP successes by further reducing clinician burden, particularly for small practices. QPP was named the top regulatory burden for medical practice leaders for the second consecutive year in 2018, according to a Medical Group Management Association (MGMA) survey.

CMS has also noticed that clinicians in small practices are also still receiving negative MIPS payment adjustments, the blog post stated.

“[W]e have heard from clinicians and stakeholders that the program, specifically MIPS, remains overly complex due to the use of broad clinician flexibility,” Verma wrote. “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.”

CMS plans to announce changes to MIPS soon, Verma added in the blog post.