QPP in Year 1

How did radiologists do in the first performance year?

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The Quality Payment Program (QPP) performance scores are in for 2017 — the first performance year under the QPP. These results provide an early glimpse into how physicians and other healthcare providers fared under the program. In general, physicians (including radiologists) did quite well in year 1, but the bonus payments were underwhelming.
Before discussing the 2017 results, let’s review some basics. The QPP has two payment arms: the Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). A hybrid of the two, called the MIPS-APM, also exists. Of the two payment arms, the more commonly reported one is MIPS. Under MIPS, all eligible providers, referred to as eligible clinicians (ECs), receive a score from 0 to 100. A threshold score is assigned above which a positive adjustment (bonus) is earned and below which a negative adjustment (penalty) is incurred. ECs who participate in an advanced APM at a required level of either payment amount or percentage of patients are exempt from MIPS. They receive an additional bonus and are referred to as qualified providers (QPs).
In 2017, more than a million physicians and qualified healthcare providers participated in the QPP. In round numbers, there were 1 million MIPS ECs, 100,000 QPs, and approximately 50 MIPS-APM participants. CMS labeled 2017 as a transitional year, which made participation — and avoidance of a penalty — relatively easy. The 2017 threshold score of 3 took minimal effort to satisfy, and the ability to score even higher on the 0–100 scale proved quite attainable. Among the 1 million MIPS ECs, the median performance score was 89. Those practices reporting via the group option did better than practices reporting as individuals (the median was 91 for group reporting versus 60 for individual). Large practices did better than small practices (90 for large versus 38 for small). About 95 percent of ECs either scored neutral or received a bonus. A remarkable 71 percent received a performance bonus and an additional positive adjustment for exceptional performance. Only 5 percent of MIPS participants (see table) suffered a penalty.1
What do these high scores mean in dollars and cents? MIPS is a budget-neutral system, meaning losers pay winners. Since there were few losers in 2017, the required budget neutrality scaling factor was less than 1 (0.3 to be exact). As such, even with the exceptional performance funds earned, the maximum positive adjustment for a perfect score of 100 was only 1.88 percent.1 The maximum penalty was 4 percent.
The QPP will continue to evolve. Full implementation was intended for 2019, but this date has been delayed due to the Bipartisan Budget Act of 2018.2 Regardless, the performance threshold will increase from 15 for 2018 to 30 for 2019. The exceptional bonus threshold is also increasing to 75 for 2019. As a result of these updates, participation will require greater effort by ECs to avoid a penalty and to score favorably. The percentage bonus may increase, as there will be more losers to pay winners. This may provide more motivation and justify investment.
Two trends are especially relevant: large practices performed better than small practices and the group reporting option allowed for higher scores. The value of group reporting was recently validated by researchers who found a larger number of reported measures, in addition to higher scores.3 The development of advanced APMs has been slow. Most radiologists will be paid through fee-for-service for the foreseeable future, which makes MIPS especially relevant to us. Moreover, our QPP results will be available to the public via the Physician Compare tool on Medicare’s website. The Commission on Economics and the Commission on Quality and Safety remain committed to helping our members succeed in the QPP.
By Ezequiel Silva III, MD, FACR, Chair
1. 2017 Quality Payment Program Performance Year Data at a Glance. CMS.
Accessed Nov. 10, 2018. Available at bit.ly/2017_QPPData.
2. Silva, E. The Slowing of the Quality Payment Program. ACR Bulletin.
2018; 73(6): 8. Available at bit.ly/QPP_Slowing.
3. Rosenkrantz A, Duszak R, Nicola G. Radiologist Group Performance
Reporting: Power in Numbers. J Am Coll Radiol. 2018. Available at bit.ly/

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