Changes In Clinicians' Participation Across Medicare Value-Based Payment Models, 2017-22

The Centers for Medicare and Medicaid Services (CMS) aims to transition all traditional Medicare beneficiaries from standard fee-for-service arrangements to accountable care relationships in conjunction with its broader value-based payment initiative, the Quality Payment Program (QPP). We constructed a longitudinal cohort of clinicians who billed Part B services during the period 2017-22, to describe changes in clinicians' participation across QPP payment models. The share of clinicians who were QPP exempt (with no value-based payment model participation in Part B) increased from 27.5 percent in 2017 to 38.1 percent in 2022. Clinicians' participation decreased from 46.3 percent to 26.7 percent in the traditional Merit-based Incentive Payment System, increased from 0.9 percent to 1.4 percent in Alternative Payment Models other than accountable care organizations (ACOs), decreased from 17.9 percent to 11.7 percent in one-sided ACOs, and increased from 7.3 percent to 22.2 percent in two-sided ACOs. CMS may face increasing difficulty improving population-level outcomes through accountable care, as a growing share of clinicians do not participate in value-based models.