CMS Releases Year 1 Results of the QPP

April 5, 2019

Late last month, CMS released comprehensive data on results from Year 1 of the Medicare Quality Payment Program (QPP). This program, implemented under the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, significantly changed the way providers are paid for Medicare Part B services and advances the goal to move toward value-based care.

Under QPP, there are 2 pathways to receive payment:
  1. Merit-based Incentive Payment System (MIPS), a program that bases payment on 4 metric categories—Quality, Improvement Activities, Promoting Operability, and Cost
  2. Advanced Alternative Payment Models (Advanced APMs), a path that bases payment on required percentages of care provided to Part B payments or patients. (Examples of Advanced APMs are accountable care organizations [ACOs], patient-centered medical homes, and bundled payment models.)
Unless an exception was met, eligible providers were required to participate in 2017 in either the MIPS or an Advanced APM. However, CMS made some last-minute changes to the first year of reporting, offering participants to “Pick Your Pace” to encourage more participation in MIPS. Participants could choose to submit some data to avoid a penalty, report 1 or more measures for a 90-day period for a small bonus, or report on all categories for any 90 consecutive days to receive a modest bonus. (In the second year of MIPS, CMS changed the requirements to include a full year of reporting.) Providers who participated in MIPS or an Advanced APM will receive payments in 2019 for what they reported in 2017.

Highlights of the data findings include:
  • 95% of providers avoided the MIPS penalty (maximum of 4%); 22% will receive a small bonus, 71% will receive a modest bonus, and 2% will receive neither a penalty nor bonus.
  • Almost 100,000 providers will receive the associated 5% bonus under the Advanced APM track, with a majority of these providers enrolled in ACOs under the Medicare Shared Savings Program, followed by those in the Next Generation ACO model.
  • Even with the option to “Pick Your Pace,” across all MIPS performance categories, eligible providers who participated generally opted to report data for 90 days or longer.
  • The majority of eligible providers reported under MIPS as part of a group (54%, or 542,202/1,006,319).
  • 94% of eligible providers in rural practices participated in MIPS, which was about the same as the overall average.
  • Similarly, 81% of eligible providers in small practices participated in MIPS, a higher percentage than under the legacy CMS quality initiatives.
CMS believes the first year of the program to be more successful than anticipated. Given the requirements change from year to year, it will be interesting to see if the participation trends remain as high as the first year and whether or not providers are really meaningfully engaged in the transition from fee-for-service to value-based care.

Health Policy Weekly is written by Xcenda, a consultancy and business unit of AmerisourceBergen Specialty Group. Visit Xcenda’s online archive to access more health policy news.

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