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Rep. Tom Price, HHS Secretary Nominee, Sharply Questioned in Senate HELP Committee Hearing

January 18, 2017
by Mark Hagland and Rajiv Leventhal
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Rep. Tom Price, the nominee for Health and Human Services Secretary, is closely questioned in Senate hearing

In the courtesy confirmation hearing taking place in the Health, Education, Labor and Pensions (HELP) Committee in the United States Senate on Wednesday, Rep. Tom Price has been undergoing very rigorous questioning from Democratic senators, while receiving praise and support from Republican senators, as he seeks to become the next Secretary of Health and Human Services, as nominated by President-elect Donald Trump.

Rep. Price (R-Ga.) was introduced to the HELP Committee by HELP Committee Chairman Sen. Lamar Alexander (R-Tenn.), who, as he began his questioning of Price, made a series of comments about the Affordable Care Act (ACA), which Republicans in Congress are attempting to repeal and replace. Alexander, who is one of two key Senate committee chairs with jurisdiction over any action the Senate might take to repeal or even modify the ACA, stated that he supported repeal “when there are concrete practical reforms in place that give Americans affordable access to healthcare. It’s not about developing a quick fix,” he added. That statement will be read widely for its possible import in that evolving situation.

Meanwhile, turning to. Price, Alexander asserted that “The individual health insurance market in Tennessee is collapsing,” placing the blame for what he characterized as a “collapse” on the ACA. “I’m told that we need to have a rescue plan in place by March 1. Do you agree that the market is collapsing and that we need a rescue plan and that March 1 is an important date for action?” Price agreed, saying that “Something is going badly wrong out there, and it's imperative for us to put things into place” to fix that situation.

Several times throughout the hearing, Price reiterated the six pillars of what he thinks make up an effective healthcare system: affordability; accessibility; quality; innovation; responsibility; and choices. When asked by Alexander about ACA “repeal and replace” processes, Price hammered home these six pillars time after time. He was asked multiple times about the fear of Americans losing healthcare coverage with whatever new plan the Trump administration puts in place, to which he said, “That is not our goal, nor is it our desire,“ adding, "options will need to move out of D.C. and into the hands of patients and their families.” The two Congressman together said that if Price were to get confirmed as HHS Secretary, his federal healthcare plan would likely be revealed sometime in February.


Sen. Patty Murray questions Rep. Tom Price in a HELP Committee hearing on Wednesday

Pressed hard on the question of whether he regarded healthcare, and health insurance coverage, as a right, by Sen. Bernie Sanders (D.-Vt.), Price averred that he supported “access” to affordable health insurance for Americans. Sanders shot back that “I have access to buying a $10 million house, but that doesn’t mean that I can afford to buy one.” When Sanders pressed him on the promise made during the presidential election campaign by Donald Trump, and whether President-elect Trump would honor his campaign promise to not cut or harm Social Security, Medicare, or Medicaid programs, he said that he had no reason to believe that Trump would do so.

Sanders and Price continued a contentious discourse in which the Senator said the U.S. is the “only major country on Earth that doesn’t guarantee healthcare to all people as a right.” Price said, “We are a compassionate society,” a statement which Sanders refuted. “No, we’re not. Compared to other countries, we are not particularly compassionate,” Sanders said. Price then noted that other countries’ healthcare system decisions have consequences. “I want to make sure every American has access to healthcare,” he said. Sanders replied, “That’s not a guarantee.”

Moments earlier, Sen. Patty Murray (D-Wash.) had criticized Republicans for “rushing” the confirmation process, and told Price that she had “serious concerns about your qualifications and plans for the department you hope to lead.” She noted that, “Just last week, you voted to begin the process of ripping apart our healthcare system without any plan to replace it,” Murray said. “My constituents are coming up to me with tears in their eyes, wondering what the future holds for their healthcare given the chaos Republican efforts could cause.”

Murray also questioned Price very closely on his investments in healthcare firms. Among Price’s holdings are some in Innate Immunotherapeutics, Ltd., a biomedical company in which another lawmaker, Rep. Chris Collins (R-N.Y.) is a major shareholder. According to his financial disclosure statements, on Aug. 31 he bought between $50,001 and $100,000 worth of stock the firm, as noted in an article in the online publication STAT. Murray strongly challenged Price’s explanations of how he came to invest in Innate Immunotherapeutics. That involvement has loomed as an issue that could potentially hurt Price’s chances as HHS Secretary.

Indeed, throughout the hearing, Price was pressed by Democratic senators about the Innate Immunotherapeutics investment as well his purchase of shares in medical device manufacturer Zimmer Biomet last year. A CNN report this week noted that “Price bought between $1,001 to $15,000 worth of shares last March in Zimmer Biomet, and “less than a week after the transaction,” Price introduced legislation “that would have delayed until 2018 a Centers for Medicare and Medicaid Services (CMS) regulation that industry analysts warned would significantly hurt Zimmer Biomet financially once fully implemented.”

Sen. Al Franken (D-Minn.) was not buying Price’s claim that the Zimmer Biomet stock was purchased by a broker, without the Congressman’s knowledge, and noted during the hearing, “How can you say you didn’t know? These sound like sweetheart deals [in reference to the Innate Immunotherapeutics purchasing opportunity that was allegedly a private offering only available to 20 people].” Sen. Franken continued, “In Congress, we want to avoid the appearance of conflict, and you have not done this.”

But, Republican senators Rand Paul (R-Ky.) and Orrin Hatch (R-Utah) jumped to the defense of Price regarding these ethical questions that have been brought up. “I consider this an attack on you,” Sen. Hatch said. Sen. Paul added, “To question the motives and your honesty is insulting. You didn’t go to the public service to take a pay cut, did you?” In response to all this, Price had this to say during the hearing: “Everything we have done as been above board, legal, ethical, and transparent,” further making note of various ethics committees that had to approve these deals. “Not a single piece of information was [held from] the public,” Price said.

Pressed by Sen. Tammy Baldwin (D.-Wis.) on whether he would support the stated position of President-elect Trump that he would push for a change of law to allow Medicare to negotiate drug prices with pharmaceutical companies, Price refused to say.

When Sen. Pat Roberts (R.-Kan.) criticized a number of agencies within the Department of Health and Human Services, most specifically the Centers for Medicare and Medicaid Innovation (CMMI), Price agreed strongly with him, saying, “I’m a strong proponent for innovation, but in some cases, what’s coming out of CMMI is the desire to require certain kinds of treatment for certain disease entities that may not be in the patient’s best interest. But because it carries the full force of the federal government,” the force of CMMI rules or recommendations is overbearing and burdensome to providers and patients, he asserted.

And, later on, Sen. Elizabeth Warren (D-Mass.) went back to the Zimmer Biomet question, pressing Price on how the stock purchases were made. Did not Price himself make the purchases? “The stock was bought by a broker; I wasn’t making those decisions,” Price said. “Was the stock purchased through an index fund?” Warren asked him. “A passively managed mutual fund? An actively managed mutual fund? A blind trust? Let’s be clear: this is not a stockbroker, this is someone who buys and sells stock at your direction.,” she said. “When you found out that your broker had made this trade without your knowledge, did you reprimand her? Did you fire her? Did you sell the stock?”

“What I did was comply with the rules of the House in an ethical and transparent way,” Price responded.

“Your periodic transaction report notes that you were notified of this trade on April 4, 2016,” Warren told him. “Congressional records showed that after you were personally notified of this trade, that you added 23 out of your bill’s 24 cosponsors. You sent a letter to CMS calling on them to cease all current and future initiatives around this bundles.”

What’s more, as Adam K. Raymond and Margaret Harmann reported in New York Magazine on Monday, “Appearances only got worse as 2016 went on and Zimmer Biomet’s PAC cut Price a check for $1,000.” The magazine quoted Larry Noble of the Campaign Legal Center, who had told CNN, “It clearly has the appearance of using your influence as a congressman to your financial benefit.”

Things may become more complicated around this issue, as Senate Democrats focus on it as a possible obstacle to confirmation. In a pair of tweets on Monday evening, Sen. Charles Schumer tweeted, first, this, referencing the Office of Congressional Ethics: “OCE needs to conduct an immediate, thorough investigation into Rep. Price's potential violations of the STOCK Act before nom moves forward.” And then he tweeted this: “This isn't just a couple of questionable trades, but rather a pattern of Rep Price trading stock & using his office to benefit those cos.”

Wednesday’s hearing in the Senate HELP Committee is referred to as a “courtesy” hearing; the Senate Finance Committee is the confirming committee, the committee that will actually vote on the Price nomination, scheduled for Jan. 24

Healthcare Informatics will continue to update readers on this evolving story.

 

 


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Healthcare Industry Could Save $12.4B With Full Adoption of Electronic Transactions

January 17, 2019
by Heather Landi, Associate Editor
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The healthcare industry continues to make progress automating business processes, but significant gaps remain, representing an opportunity for $12.4 billion in savings through further automation, according to new data from the 2018 CAQH Index.

Electronic adoption and transaction volume increased in 2018, with several common transactions reaching 80 percent electronic adoption across the sector, according to the latest CAQH Index. This progress resulted in a narrowing of the cost savings opportunity for the first time in CAQH Index history.

CAQH is a Washington, D.C.-based non-profit alliance of health plans and trade associations. The findings from the 2018 CAQH Index are based on voluntary nationwide surveys of providers, as well as commercial medical and dental health plans. Participating medical health plans represent over 160 million covered lives—nearly 49 percent of the commercially insured U.S. population—and 7.8 billion transactions conducted in 2018.

The sixth annual CAQH Index is an annual report tracking the adoption of HIPAA-mandated and other electronic administrative transactions between healthcare providers and health plans in the medical and dental industries. These transactions include verifying a patient’s insurance coverage, obtaining authorization for care, submitting a claim and supplemental medical information and sending and receiving payments. The CAQH Index also estimates the annual volume of these transactions, their cost and the time needed to complete them.

By benchmarking progress, industry and government can more easily identify barriers that may be preventing stakeholders from realizing the full benefit of electronic administrative transactions. These insights can prompt new initiatives to address and reduce barriers. For the report, data was submitted by medical and dental plans that cover roughly half of the insured population in the United States and providers representing a range of specialties.

After reporting modest progress over the past few years, the 2018 CAQH Index findings suggest more positive change is occurring in the industry overall. Healthcare industry stakeholders made progress on many fronts this year—in adoption of electronic transactions, reductions in the volume of manual transactions and reductions in the remaining savings opportunity.

“The results highlighted in the 2018 Index are encouraging,” Kristine Burnaska, director of research and measurement at CAQH, said in a statement. “Both providers and health plans are saving time and reducing administrative costs, but more effort is needed to significantly reduce the volume of expensive, time consuming manual processing.”

While the overall volume of transactions in the medical industry increased by 18 percent in the past year, the volume of manual transactions declined, falling 6 percent for health plans and 1 percent for providers, according to the CAQH Index.

Medical industry adoption of electronic eligibility and benefit verification increased six percentage points to 85 percent in 2018; adoption of electronic coordination of benefits rose to 80 percent in 2018, up from 75 percent in 2017. Adoption of electronic claim submission stands at 96 percent and 71 percent of healthcare organizations have adopted electronic claim status inquiries.

However, the healthcare industry made little progress in the adoption of other electronic administrative transactions—only 12 percent of organizations have adopted electronic prior authorization, although that is up from 8 percent the year before. Adoption of electronic claim payment stands at 63 percent and less than half of healthcare organizations (48 percent) have adopted electronic remittance advice processes.

However, continued efforts are needed to significantly reduce the volume of expensive, time-consuming manual transactions and adapt to the changing administrative needs of the healthcare system, according to the CAQH Index. The Index estimates that the medical and dental industries could save an additional $12.4 billion annually with full adoption of electronic administrative transactions, particularly through greater automation by providers, which could save an additional $8.5 billion.

During a period of rising transaction volume, the medical industry shaved $1.3 billion from its savings opportunity, bringing it to $9.8 billion.

The Index also highlights a substantial rise in overall transaction volume, growing in parallel with industry complexity. As these trends persist, the Index finds that the industry would benefit from updated standards, operating rules, infrastructure and functionality that can accommodate the increase in volume and growing complexity associated with the need to connect administrative and clinical data elements in value-based payment models.

“The industry is making progress,” April Todd, senior vice president, CORE and Explorations at CAQH, said in a statement. “But, we are at an inflection point where processes and technology must adapt to a healthcare system that is transitioning to value-based payment and becoming increasingly complex.”

The CAQH Index notes that industry complexity is growing in parallel with transaction volume. “As these trends persist, the industry will benefit from standards, operating rules, infrastructure and functionality that can accommodate both the increase in volume and the growing complexity associated with varying plan and payment models designed to increase the value and quality of healthcare for consumers. There is a need for all stakeholders to support initiatives that lay the groundwork for the future,” the report authors wrote.

The CAQH Index also issued a number calls to action for the healthcare industry, including focusing efforts to address cost savings opportunities. Several transactions offer the greatest potential for savings and should be the subject of attention—transactions include eligibility and benefit verification, claim status, remittance advice and prior authorization. The medical industry could save an additional $4 billion on eligibility and benefit verifications and $2.6 billion on claim status transactions by fully adopting electronic transactions, according to the CAQH Index.

CAQH also recommends accelerating standards and operating rule development and encouraging timely vendor adoption of standards and operating rules.

 

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Has CMS Just Tipped the Scales Towards Provider Alienation, in its ACO Final Rule?

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CMS’s release of its final rule on MSSP ACO participation has pushed the healthcare industry into a very fraught moment in the ongoing evolution of the ACO experiment

As Healthcare Informatics Associate Editor Heather Landi reported on Dec. 21, that morning, “The Centers for Medicare & Medicaid Services (CMS) on Friday morning published a final rule that makes sweeping changes to the Medicare Shared Savings (MSSP) Accountable Care Organization (ACO) program, with the goal to push Medicare ACOs more quickly into two-sided risk models.”

Indeed, as Landi noted in her report, “Referred to as ‘Pathways to Success,’ the Trump Administration’s overhaul of Medicare’s ACO program will redesign the program’s participation options by removing the traditional three tracks in the MSSP model and replacing them with two tracks that eligible ACOs would enter into for an agreement period of no less than five years: the BASIC track, which would allow eligible ACOs to begin under a one-sided model and incrementally phase in higher levels of risk; and the ENHANCED track, which is based on the program’s existing Track 3, providing additional tools and flexibility for ACOs that take on the highest level of risk and potential rewards. At the highest level, BASIC ACOs would qualify as an Advanced Alternative Payment Model (APM) under the Quality Payment Program.”

And, Landi noted, “Currently, the MSSP model includes three tracks and is structured to allow ACOs to gain experience with the program before transitioning to performance-based risk. The vast majority of Shared Savings Program ACOs have chosen to enter and maximize the allowed time under Track 1, which is an ‘upside-only’ risk model. MSSP Tracks 2 and 3 involve downside risk, but participation in these tracks has been limited thus far.”

One of the biggest points of contention in recent months as centered on how aggressive a push on the part of CMS to compel providers forward into two-sided risk would be desirable, or even wise. Some in the industry tried to put a positive spin on the “low-income” element of the program, with that term referring to smaller physician groups choosing to participate in the MSSP. On Friday morning, in response to the final rule, Travis Broome, vice president of policy at Aledade, a Bethesda, Md.-based company focused on physician-led ACO development, tweeted, “One more change to Basic. Low-revenue ACOs will be able to stay in 1-sided risk for 3 years. Difference [between] 2 & 3 years is big. The decision to take risk is made summer before the year starts. So 2 years of 1-sided risk meant making the risk decision before year 1 results even came in.”

But in a statement from the National Association of ACOs (NAACOS), an association comprised of more than 360 ACOs, Clif Gaus, Sc.D., NAACOS’s president and CEO expressed concern that CMS retained the two-year limit for other ACOs. “Becoming a well-functioning ACO takes time and requires building of IT infrastructure, hiring care coordinators, changing the culture of providers, among other tasks. Under CMS’s proposed rule, many ACOs would have just a single year of performance data available to them before evaluating the required move to risk in their third year of the program,” Gaus stated.

Gaus did include a conciliatory note in his statement, saying that "We appreciate CMS' effort in the final rule to provide greater stability to the Medicare Shared Savings Program with five-year agreement periods and more flexibility through waivers for telehealth and skilled nursing facility stays. We look forward to working with CMS to ensure that the Medicare Shared Savings Program, which has a track record of saving taxpayer hundreds of millions of dollars while demonstrably improving care for patients, continues to attract new participants and reap savings." NAACOS has been among the most vocal of healthcare professional associations this year, as CMS Administrator Seema Verma has intensified her call for providers to move forward quickly into more advanced forms of alternative payment models.

But, choosing not to sound any notes of conciliation on Friday, was the Chicago-based American Hospital Association, the largest U.S. hospital association, representing nearly 5,000 hospitals nationwide. A statement attributed to Tom Nickels, AHA vice president, on Dec. 21, said, “Today’s final rule will not be helpful in the move toward value-based care. None of the actions taken today will better empower ACOs to maximize their contribution to patient care and are not pathways for improving the value of the program for patients. We remain opposed to CMS drastically shortening the length of time in which ACOs can participate in an upside-only model. Hospitals and health systems have asked for a more gradual pathway because building a successful ACO that is able to take on financial risk requires significant investments in time, effort and finances.”

Further, the AHA statement said, “While CMS made some improvements to its shared savings rate policies from the proposed rule, they still are not sufficient to appropriately reward ACOs for improving quality and reducing costs. We are particularly concerned about the impact of these and other policies on high-revenue ACOs. We do appreciate that CMS took certain steps to expand participants’ ability to provide care to beneficiaries – for example, via telehealth and longer agreement periods.”

And, the AHA said, “As a whole, the policies in the rule will likely result in a significant decrease in program participation. That would be unfortunate, as we seek to transform care to better serve our patients and communities.”

While the Centers for Medicare & Medicaid Services (CMS) finalized some improvements to the Medicare Shared Savings Program (MSSP), the Premier healthcare alliance is extremely concerned that these are overshadowed by unrealistic expectations of the speed at which providers can transition to risk-based tracks, the un-level playing field created for hospital-led vs. physician-led ACOs and the imbalance of risk vs. reward.

Meanwhile, leaders at the Charlotte-based Premier Inc. were equally critical. In a statement released on Friday, Blair Childs, Premier’s senior vice president of public affairs said that while “Premier appreciates that CMS finalized the extension of waivers and the longer agreement period and heard our concerns about the reduction in shared savings,” “We are extremely disappointed, however, that CMS has moved forward in creating an unlevel playing field that disadvantages high-revenue ACOs—primarily hospital-led ACOs. Premier and other stakeholders, including MedPAC, oppose this policy,” the statement read. “Hospital-led ACOs in Premier’s Population Health Management Collaborative performed twice as well as all the other ACOs nationally. CMS should be taking steps to enhance, not limit, the inclusion of all innovative providers that are seeking to move to value-based care. For an Administration that has been outspoken in advocating for market solutions and level playing fields among competitors, it’s an enormous mistake to finalize a policy that pits providers against each other rather than focusing on collaboration, as the model intends.”

So, where does this leave the industry? Quite possibly, at an important inflection point, now that what was a proposed rule is now a final rule. One could argue this situation from a number of standpoints, but the bottom line is simple: in her desire to push providers forward quickly and decisively into two-sided risk—and even with the carrot-like incentives for smaller physician groups that have been added—Administrator Verma is now strongly risking a massive wave of defections from the MSSP.

As NAACOS’ Gaus noted in his statement, “Under CMS's proposed rule, many ACOs would have just a single year of performance data available to them before evaluating the required move to risk in their third year of the program.” Perhaps similarly importantly, he noted, "Although we are pleased that CMS finalized a new, limited exception to its high-low policy, we remain concerned that the high-low revenue ACO distinction could deter providers who want to embark on the path of value-based care and could unintentionally harm physician-led ACOs. We urged CMS in the rulemaking process to provide an equal playing field for all ACOs and will continue to advocate for changes to this policy. A NAACOS analysis of how ACOs would be classified under CMS's proposed definitions found almost 20 percent of physician-led ACOs would be considered high revenue ACOs. Furthermore, federally qualified health centers and rural health clinics would also have a fair proportion of high revenue ACOs.”

So, here we come to a very tricky set of issues. First, the entire point of adding in the “low-income ACO” distinction was to encourage more physician groups to join the MSSP; and that would be very important for the survival and thriving of the program, since the participation of hospital-based organizations has been slow to date, and one key way to encourage participation by all types of patient care organizations would be to be able to boast about rapidly increasing participation. But if, as Gaus has noted, NAACOS’ analysis finds that nearly 20 percent of physician-led ACOs would actually end up being “high-revenue ACOs,” that could indeed complicate CMS’s attempts to quickly gain new participants.

Further, the short period of time between initial participation and having to decide whether to stay in the voluntary program and take on mandated two-sided risk, poses one of the most serious barriers to increased participation; and therein lies the real rub for CMS, because if this final rule ends up causing mass defections in the next two years, the agency’s signature and largest federal ACO program could begin to fall apart, precisely at the time that Administrator Verma, Health and Human Services Secretary Alex Azar, and all their fellow senior federal healthcare policy officials, would be hoping to accelerate the shift from volume to value in U.S. healthcare, and prove that the broad ACO experiment is working.

On the other hand, it’s also true that if CMS allows the forward evolution of the MSSP program to progress too slowly, that could cause members of Congress and their staffs to determine that voluntary programs simply aren’t cutting it, and move towards massive Medicare cuts instead, in an attempt to get better control of overall U.S. healthcare inflation, at a time when all discretionary spending in the federal budget is increasingly becoming politically fraught.

For the time being, there is no simple answer to any of this. It’s as though the levers of power and influence must be used in an exquisitely calibrated way. There seems to be no “Goldilocks pace” of change here that will both maximize new participation, and ongoing participation, in the MSSP program, on the part of wary providers, and yet also fulfill all the demands and desires of senior federal healthcare policy officials. Only time will tell, but this moment feels more fraught than ever, in the ongoing evolution of the ACO experiment. There’s no doubt that 2019 could be a determinative year for MSSP.

 

 

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CMS: 93% of Clinicians Get Positive Payment Adjustments for MIPS Year 1

November 8, 2018
by Rajiv Leventhal, Managing Editor
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Ninety-three percent of MIPS (Merit-based Incentive Payment System)-eligible clinicians received a positive payment adjustment for their performance in 2017, and 95 percent overall avoided a negative payment adjustment, according to a CMS (Centers for Medicare & Medicaid Services) announcement today.

The first year of MIPS under MACRA’s Quality Payment Program (QPP) was dubbed by CMS as a “pick your pace year,” which essentially enabled clinicians to avoid payment penalties as long as they submitted at least the minimum amount of quality data. As such, in its announcement, CMS did admit that the overall performance threshold for MIPS was established at a relatively low level of three points, and the availability of “pick your pace” provided participation flexibility through three reporting options for clinicians: “test”, partial year, or full-year reporting.

CMS said that 93 percent of MIPS-eligible clinicians received a positive payment adjustment for their performance in 2017, and 95 percent overall avoided a negative payment adjustment. CMS specifically calculated that approximately 1.06 million MIPS-eligible clinicians in total will receive a MIPS payment adjustment, either positive, neutral, or negative. The payment adjustments for the 2017 program year get reflected in 2019.

Breaking down the 93 percent of participants that received a positive payment adjustment last year, 71 percent earned a positive payment adjustment and an adjustment for exceptional performance, while 22 percent earned a positive payment adjustment only. Meanwhile, just 5 percent of MIPS-eligible clinicians received a negative payment adjustment, and 2 percent received a neutral adjustment (no increase or decrease).

Of the total population, just over one million MIPS-eligible clinicians reported data as either an individual, as a part of a group, or through an Alternative Payment Model (APM), and received a neutral payment adjustment or better. Additionally, under the Advanced APM track, just more than 99,000 eligible clinicians earned Qualifying APM Participant (QP) status, according to the CMS data.

CMS Administrator Seema Verma noted on the first pick-your-pace year of the QPP, “This measured approach allowed more clinicians to successfully participate, which led to many clinicians exceeding the performance threshold and a wider distribution of positive payment adjustments. We expect that the gradual increases in the performance thresholds in future program years will create an evolving distribution of payment adjustments for high performing clinicians who continue to invest in improving quality and outcomes for beneficiaries.”

For 2018, the second year of the QPP, CMS raised the stakes for those participating clinicians. And in the third year of the program, set to start in January 2019, a final rule was just published with year three requirements. Undoubtedly, as time passes, eligible clinicians will be asked for greater participation at higher levels. At the same time, CMS continues to exempt certain clinicians who don’t meet a low-volume Medicare threshold.

Earlier this year, CMS said that 91 percent of all MIPS-eligible clinicians participated in the first year of the QPP, exceeding the agency’s internal goal.

What’s more, from a scoring perspective in 2017, the overall national mean score for MIPS-eligible clinicians was 74.01 points, and the national median was 88.97 points, on a 0 to 100 scale. Further breaking down the mean and median:

  • Clinicians participating in MIPS as individuals or groups (and not through an APM) received a mean score of 65.71 points and a median score of 83.04 points
  • Clinicians participating in MIPS through an APM received a mean score of 87.64 points and a median score of 91.67 points

Additionally, clinicians in small and rural practices who were not in APMs and who chose to participate in MIPS also performed well, CMS noted. On average, MIPS eligible clinicians in rural practices earned a mean score of 63.08 points, while clinicians in small practices received a mean score of 43.46 points.

Said Verma, “While we understand that challenges remain for clinicians in small practices, these results suggest that these clinicians and those in rural practices can successfully participate in the program. With these mean scores, clinicians in small and rural practices would still receive a neutral or positive payment adjustment for the 2017, 2018, and 2019 performance years due to the relatively modest performance thresholds that we have established. We will also continue to directly support these clinicians now and in future years of the program.”

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