Blog | MACRA

Analysis: CMS releases 2018 QPP participation results

Blog | MACRA

Analysis: CMS releases 2018 QPP participation results

  • The Centers for Medicare and Medicaid Services (CMS) released results of physician participation in the Quality Payment Program on July 12.
  • 98% of eligible clinicians participated in Merit-based Incentive Payment System (MIPS), which is an increase from 95% the prior year.
  • The numbers improved because CMS significantly increased the exclusions in the 2018 performance year.

On July 12, the Centers for Medicare and Medicaid Services (CMS) released results of physician participation in the Quality Payment Program.

The release touts that in 2018:

  • 98% of eligible (emphasis added) clinicians participated in the program’s Merit-based Incentive Payment System (MIPS), which is an increase from 95% the prior year.
  • 90% of clinicians in small practices participated in MIPS, an increase from 81% the prior year.
  • 97% of physicians exceeded the performance threshold of 15 points compared to 93% of physicians in the prior year. In 2017 clinicians only had to achieve three points — submit one measure — to meet the threshold.

The number of physicians who qualified for the Advanced Alternative Payment Model bonus (an increase equal to 5% of Part B billing) almost doubled increasing from 99k to 183k this year.

Takeaway

What’s driving improvement? The numbers improved because CMS, starting with the 2018 performance year, significantly increased the exclusion criteria for small practices or those that don’t have a large book of Medicare business.

The 2018 QPP final rule exempted physician practices with less than $90,000 in Medicare revenue (up from $30k in the 2017 QPP rule) or fewer than 200 unique Medicare patients per year (up from 100 in the 2017 QPP rule).

Smaller practices (or those with fewer Medicare beneficiaries) are less likely to participate in MIPS due to the compliance costs. Therefore, pulling small practices out of the denominator will improve the participation percentage.

What’s the average MIPS payment for the 2020 payment (2018 performance) year? The materials released by CMS do not provide the amount of the average adjustment for MIPS participants. However, unless you qualify for the exceptional performance bonus payment (for achieving 70 or more points), it can’t be much.

The MIPS program is budget neutral meaning that providers who are penalized fund the bonus payments for those above. And since only 1.95% of providers were below the threshold (.42% scored exactly 15 points and so were at the threshold), there isn’t a lot of cash in the till to pay bonus payments. 

About the Authors

Chad Mulvany, FHFMA

is director, healthcare finance policy, strategy and development, HFMA’s Washington, D.C., office, and a member of HFMA’s Virginia-Washington, D.C., Chapter.

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