Centers for Medicare and Medicaid Services (CMS) has released and updated the 2020 Quality Payment Program (QPP) Experience Report which identifies trends associated with the clinician experience in both the MIPS and APM tracks. 

In this blog, we'll review what trends and changes were seen in the fourth year of the QPP. 

What Did the 2020 QPP Experience Report Find?

The overwhelming driver of change in the clinician experience in the QPP is, unsurprisingly, the COVID-19 pandemic:

• The cost category was re-weighted in 2020 for all clinicians, groups, and virtual groups.

• The automatic MIPS Extreme and Uncontrollable Circumstances (EUC) policy for individual MIPS clinicians and the extended application deadline for others led to neutral scores for individuals, and category re-weighting for others that skew the available data. 

• The new Improvement Activity, "COVID-19 Clinical Data Reporting with or without Clinical Trial", was reported on by over 33,000 clinicians (5.5% of those that reported in this category). 

• The measure "All-Cause Unplanned Hospital Readmission" measure was suppressed.

Engagement Trends

Engagement statistics reflect the percentage of eligible clinicians who report data to CMS.

• After steadily increasing rates of engagement from 2017-2019, the 2020 engagement rate decreased 7% in 2020 to 90%.  

• CMS asserts that this decline in engagement is due to the EUC policies disincentivizing the report of data to ensure a score equal to the performance threshold.

Performance and Payment Adjustment Trends

• Even with expanded EUC availability, the number of clinicians receiving a negative payment adjustment increased six-fold compared to 2019. 

• The performance threshold increased dramatically in 2020, from 30 to 45 points. Even with this higher threshold, the percentage of clinicians who achieved scores above the performance threshold stayed close to the same (only a 2% difference). This implies that clinicians ability to achieve high scores is improving. In 2020, MarsdenAdvisors clients scored almost 10 points above the national average and 88% of our clients got a perfect (100%) 2020 MIPS score.

• CMS is still seeing QP growth year-over-year. This is a trend to watch as the lump-sum bonus expires and a "gap year" of incentives for APMs takes place. Will there be enough long-term benefit incentive for providers to continue to join APMs? 

• Significant gains were seen in the 2020 performance year, particularly for rural clinicians. CMS continues to monitor the trends of scoring for small and rural practices, as their scores consistently trail below other types of practices. 

Next Steps

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If you have any questions on this, let us know!