More clinicians participated in MACRA's Advanced Alternative Payment Model (Advanced APM) track and Merit-based Incentive Payment System (MIPS) in 2018, and more participating clinicians will receive positive payment adjustments, CMS Administrator Seema Verma wrote Monday in a blog post.

Background

Under MACRA's Quality Payment Program (QPP), which took effect in 2017, eligible clinicians can choose from two payment tracks:

• The Advanced APM track, for clinicians who take on a significant portfolio of Advanced APMs, which include risk-based accountable care organization (ACO) models; or
• MIPS, for providers who are reimbursed largely through fee-for-service.

Clinicians' pay in the MIPS track largely follows a traditional fee-for-service structure, but CMS adjusts eligible clinicians' pay based on how they "score" in four categories of metrics:

• Cost;
• Improvement activities;
• Promoting interoperability, formerly called Advancing care information (ACI); and
• Quality.

But for the 2020 payment year, which is based on 2018 data, eligible clinicians needed to report on a full year's worth of quality data, and CMS increased the performance threshold to 15 points for providers to avoid the 5% penalty, applied to payments in 2020. Beginning in the 2021 performance period, the new MIPS Value Pathways (MVP) participation framework will seek to overhaul MIPS reporting to reduce burden and make the program more meaningful for participating clinicians and patients.

Clinician participation rises in 2018, Verma says

In Monday's blog post, Verma wrote that 2018's participation rates for MIPS and Advances APMs exceeded 2017's participation rates. For example, Verma wrote Advanced APM participation in 2018 increased as more clinicians earned Qualifying APM Participant (QP) status. Verma wrote 183,306 eligible clinicians earned QP status in 2018—up from 99,076 eligible clinicians in 2017.

CMS in July said MIPS participation via APMs increased from 341,220 participants in 2017 to 356,828 in 2018, while MIPS participation without an APM decreased from 1,057,824 participants in 2017 to 916,058 participants in 2018.

More clinicians receive positive payment adjustments, Verma says

Verma also wrote more clinicians are expected to receive a positive payment adjustment in 2020 based on their performance in 2018. Overall, Verma wrote the "national mean (or average) and median scores increased from 2017."

According to Verma, 98% of eligible clinicians participating in MIPS will receive a positive payment adjustment in 2020 based on their 2018 performance.

Verma noted 97% of eligible clinicians in rural practices will receive a positive payment adjustment—up from 93% for the 2017 performance year. Verma wrote 84% of eligible clinicians in small practices also will receive a positive payment adjustment in 2020 for their 2018 performance, an increase from 74% in 2017.

In addition, Verma wrote 872,148 MIPS-eligible clinicians will receive a neutral or positive payment adjustment in 2020 based on their individual, group, or Alternative APM participation in 2018. According to Verma, "Clinicians who specifically participated in MIPS through an APM had a mean score of 98.77 and a median score of 100."

However, Verma wrote, "Positive payment adjustment will remain modest in part because, under the MACRA law, the positive and negative payment adjustments must be budget neutral."

According to CMS, positive payment adjustments will range from 0% to 0.20% for 13% of MIPS-eligible clinicians, with another 84% of MIPS-eligible clinicians receiving an additional adjustment for exceptional performance for a total incentive ranging from 0.21% to 1.68%. CMS data show negative payment adjustments, which will affect about 2% of MIPS-eligible clinicians, will range from -0.01% to -5%.

Verma added, "Although the results are encouraging, there are clinicians who will receive negative payment adjustments. We are committed to supporting these clinicians to reduce reporting complexity and burden, encourage meaningful participation, and improve patient outcomes" (LaPointe, RevCycleIntelligence, 1/6; Verma blog post, 1/6).