CMS: Physician uptake of advanced payment models under MACRA outpacing goals

hospital money
A new CMS report dives into trends in the first year of the Quality Payment Program. (Getty/PraewBlackWhile)

The Centers for Medicare & Medicaid Services has issued a new report that offers a look at how physicians fared the first year of its Quality Payment Program. 

QPP includes two possible tracks for doctors, the Merit-based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model. In 2017, more than 1 million doctors enrolled in MIPS, about 95% of those eligible, while more than 99,000 qualified for APM, which is a higher risk-bearing option, according to the report (PDF download). 

The participation numbers outpace CMS’ projections and goals for the program’s first year, according to the report. The agency was aiming for 90% participation in MIPS and for about 70,000 physicians to enter more advanced models. 

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The goal of releasing the data, CMS said in the report, is to effectively highlight successes and pain points that can inform QPP participation in the future. 

“We look forward to continuing to listen and identify ways to improve the Quality Payment Program to help drive value, reduce burden, and improve outcomes for our beneficiaries,” CMS wrote. 

RELATED: Medicare payments won’t cover costs for many physician practices in 2019, poll finds 

The majority of those eligible for the advanced models enrolled in the Next Generation accountable care organization program, with more than 73,600 physicians eligible to jump into that program. In addition, just over 59,000 were eligible for the Medicare Shared Savings Program and nearly 8,900 qualified for the Comprehensive Primary Care Plus Model. 

QPP was established as part of the Medicare Access and CHIP Reauthorization Act, passed in 2015 with the goal of getting more physicians to enter value-based payment models. The two tracks failed to be a hit with physicians, and the Medicare Payment Advisory Commission has recommended that Congress rethink MIPS in particular

MedPAC’s alternative, the Voluntary Value Payment model, also failed to land with physician groups, most of whom instead want to see some incremental adjustments to MIPS to help it work better for them. 

CMS’ data also dives into physician reporting habits under the two tracks. The majority chose to take advantage of longer reporting windows, with less than 1% choosing reporting periods of less than 90 days. 

RELATED: What doctors need to know about MACRA’s new patient relationship codes 

Most opted to instead use a 12-month reporting period, with more than 673,000 physicians taking that option. An additional 225,665 choose a reporting period that was longer than 90 days but less than 12 months. 

CMS’ analysis also found that small and rural practices were submitting more than the required amount of data on quality, though smaller providers may struggle in value-based models. 

“This highlights that these clinicians were committed to meaningfully participating in MIPS to continue driving value and innovating to improve patient outcomes,” CMS said. 

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