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

Area of Science:

• Health Policy
• Healthcare Economics
• Medical Practice Management

Background:

• The Centers for Medicare and Medicaid Services (CMS) is shifting Medicare beneficiaries towards value-based care.
• The Quality Payment Program (QPP) incentivizes clinicians to participate in alternative payment models.
• Understanding clinician participation trends is crucial for evaluating the success of value-based care initiatives.

Purpose of the Study:

• To analyze changes in clinician participation across various QPP payment models from 2017 to 2022.
• To identify trends in clinician exemption from value-based payment models.
• To assess the potential impact of these trends on population health outcomes.

Main Methods:

• A longitudinal cohort of clinicians billing Part B services between 2017 and 2022 was constructed.
• Clinician participation was categorized across different QPP models, including Merit-based Incentive Payment System (MIPS) and Accountable Care Organizations (ACOs).
• The proportion of clinicians participating in or exempt from value-based models was calculated for each year.

Main Results:

• The percentage of clinicians exempt from QPP increased from 27.5% in 2017 to 38.1% in 2022.
• Participation in the traditional MIPS model decreased significantly, while participation in two-sided ACOs increased.
• Participation in one-sided ACOs decreased, and participation in other Alternative Payment Models (APMs) saw a slight increase.

Conclusions:

• A growing number of clinicians are not participating in value-based payment models.
• This trend poses a potential challenge for CMS in achieving population-level health improvements through accountable care.
• Further strategies may be needed to encourage broader clinician engagement in value-based care.