At least 93 percent of providers qualified for a positive payment adjustment from 2017 through 2019 under the Merit-based Incentive Payment System, according to a new report from the Government Accountability Office.
For the report, the GAO analyzed CMS data on the payment system's performance category scores, final scores and payment adjustments from performance years 2017 to 2019, the most recent year available at the time of its study. The GAO sought to better understand the distribution of the payment system's final scores and payment adjustments to ensure the program is making a meaningful difference.
Under the payment system, providers are scored on their performance and activities in four performance categories: quality, improvement activity, promoting interoperability and cost. Scores from the four performance categories are weighted, with quality being the highest weight for the study years. Providers then are compared to a threshold set by law, and those scores result in a positive, negative or neutral payment adjustment.
Here are six things to know from the report:
1. Across the three years studied, the median final scores ranged from 89.7 to 99.6, out of a possible 100. These scores were well above the performance threshold that would have resulted in no payment adjustment or a negative payment adjustment.
2. During the study years, about 72 percent to 84 percent of providers received a bonus for "exceptional performance." .
3. No more than 4.8 percent of providers qualified for a negative payment adjustment.
4. In 2019, the median performance score for practices with one provider was 72.5, while the median performance score for an organization with more than 100 providers was 92.9.
5. The maximum positive payment adjustment for performance years 2017 through 2019 was 1.88 percent, meaning that the bonuses resulted in small increases in Medicare payments.
6. CMS said it projected its performance threshold for the payment system's final scores in performance year 2022 to be 74.01. Using data from 2019, the GAO estimates that about 84 percent of scores would have earned a positive adjustment with the higher threshold.