CMS Releases 2018 Quality Payment Program Results
On July 7, CMS released the 2018 Quality Payment Program Experience Report. The report covers various data points regarding participation and performance in the Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs) tracks of the QPP during the 2018 performance period. Key takeaways from the report’s findings are summarized below.
Small Practice and Rural Practice Performance in MIPS
While the participation rate of small practices (15 or fewer eligible clinicians) increased from 81 percent in 2017 to 88 percent in 2018, CMS notes that this increase could be due to the increase in the low-volume thresholds in 2018.
Additionally, only six percent of all participants participated as individuals, and they had lower mean and median final scores compared to those who participated as part of a group or MIPS APM.
MIPS Payment Adjustments
Eighty-four percent of eligible clinicians in 2018 achieved an exceptional performance score (70-100 points), and 13.39 percent achieved a positive performance score (15.01-69.99 points).
Since payment adjustments within MIPS are subject to budget neutrality rules, the maximum positive payment adjustment for the 2018 performance period (2020 payment period) that exceptional performers will receive is only 1.68 percent. Additionally, those who received a positive performance score will only receive a maximum adjustment of 0.20 percent. The minimal positive payment adjustment experienced (range of 0.20%-1.68%) still indicates that there is marginal reward for participation in the program.
2.01 percent of eligible clinicians received a negative adjustment. The maximum negative payment adjustment experienced was -5.00 percent.
Medicare Shared Savings Program (MSSP) Participation Drives Results
About 360,000 eligible clinicians participated in MIPS through an APM – this excludes those with QP and PQ status. The large majority of these eligible clinicians participated in Medicare Shared Savings Program (MSSP) Accountable Care Organizations (ACOs).
These participants seem to have driven the performance in the quality category, as CMS Web Interface (which is required under MSSP) was the most common submission method for quality measures.
Challenging Quality Measures
Excluding the CMS Web Interface measures, of the top 10 quality category measures that contributed to participants’ quality category score, the most challenging measures for participants seem to be:
- All-Cause Hospital Readmission – 15.29% average performance rate
- Diabetes: Hemoglobin A1c Poor Control – 39.3% average performance rate
- Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents – 48.61% average performance rate