- The number of participants in its Advanced Alternative Payment Models under the Medicare Access and CHIP Reauthorization ACT (MACRA) grew significantly last year compared to 2017, increasing to more than 183,000 from just below 100,000, according to CMS.
- The number of eligible clinicians participating in MACRA's Merit-Based Incentive Payment System (MIPS) grew to 98% last year, up from 95% in 2017. The proportion of physicians in small practices participating in MIPS grew to nearly 90% from 81%, according to the data.
- The number of practices that received a positive payment adjustment grew 11 percentage points last year, the agency said.
CMS' APMs and MIPS programs, part of the sweeping payment reforms ushered in with MACRA in 2015, are intended to incentivize cost reductions and increases in quality among providers participating in the Medicare program. However, both have come under criticism, with many physicians saying they contain too many rules and rely too much on expensive investments in EHRs to make participation worthwhile.
In response, CMS officials have tried to make the programs more flexible, offering more points of entry and adding additional initiatives. They included increases in the Medicare patient count under the Physician Fee Schedule and allowed Medicare Part B charges to participate in MIPS. According to a blog entry by CMS Administrator Seema Verma, that meant "fewer clinicians in small practices were required to participate, but results show they elected to do so anyway."
And, according to Verma, those small practices are faring better than in the past, with nearly 85% scoring high enough for a positive payment adjustment, up from about 74% in 2017.
However, the number of individual and group clinicians participating in MIPS who received a score and a payment adjustment dropped last year to 559,230, compared to 716,603 in 2018, according to a CMS infographic.
Clinicians participating in an APM program who received a score and payment adjustment grew slightly, to 356,828 in 2018, compared to 341,220 in 2017. Those that qualify for an APM receive a 5% payment bump and are excluded from the MIPS reporting requirements.
But CMS is tightening the rules for participation in 2019 for APMs. Qualifying participants must receive at least 50% of Medicare Part B payments or see at least 35% of Medicare patients through an APM entity, up from 25% and 20%, respectively. And 75% of practices need to use advanced EHR systems, up from 50% in 2018.