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The number of clinicians participating in advanced APMs increased

Participation almost doubled year-to-year, while the number of clinicians taking part in MIPS declined.

Susan Morse, Senior Editor

The number of clinicians participating in advanced alternative payment models nearly doubled in 2018 over the previous year, according to quality payment performance released by the Centers for Medicare and Medicaid Services.

The number of clinicians in advanced APMs increased from 99,076 to 183,306. They receive a 5% APM incentive payment and have been excluded from the merit-based incentive payment system reporting requirements and payment adjustments.

The number of clinicians participating in MIPS through APMs also rose, from 341,220 in 2017 to 356,828 in 2018. CMS credits this to an increase in the number of participation opportunities, particularly through Accountable Care Organizations in the shared savings program.

However, the number participating in MIPS declined year-to-year. In 2017, 1,057,824 participated, compared to 916,058 in 2018. But more scored above the performance threshold to get a positive payment adjustment: from 93% in 2017 to 97% in 2018.

Of the MIPS eligible clinicians, 98.37 percent participated in 2018; 89.2 percent of MIPS eligible clinicians in small practices participated.


The figures show success in participation in APMs, the more advanced model under the quality payment programs under MACRA.

"This increase in APM participation supports the evolution of the program and incentives toward a system of value that puts patients first," CMS said.


The quality payment program, launched in 2017, gives incentives for maximizing performance. The biggest gains were in the quality performance category that measures outcomes for beneficiaries.
Medicare beneficiaries can see the results on the Physician Compare website, which also aids in CMS transparency goals.

CMS introduced flexibilities in the quality payment program that led to 98 percent of eligible clinicians participating in 2018, up from 95 percent in 2017. Also, close to 90 percent of clinicians in small practices participated in 2018, an increase from 81 percent in 2017.

This is important because smaller practices elected to participate even after CMS made changes that required fewer of them  to take part.

However, some small practices continue to receive a negative payment adjustment. Clinicians and stakeholders have told CMS that MIPS remains overly complex due to the use of broad clinician flexibility.
CMS said it would address these concerns through such initiatives as Patients Over Paperwork and Meaningful Measures.

Twitter: @SusanJMorse
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