Updates Proposed for 2018 Physician Quality Payment Program

Posted on July 06, 2017

The Centers for Medicare & Medicaid Services (CMS) recently released a proposed rule to update the Medicare Physician Quality Payment Program in 2018. The Medicare Access to Care and CHIP Reauthorization Act (MACRA) of 2015 repealed the Medicare sustainable growth rate methodology for updates to the physician fee schedule and required the CMS to establish new physician quality and value-based payment programs. Clinicians’ 2018 performance will impact their 2020 Medicare fee-for-service payments for professional services. Key elements of the proposed rule include:

  • The Merit-based Incentive Payment System (MIPS) would score clinicians on the same categories and weights used in 2017, including Quality (60 percent), Advancing Care Information (25 percent) and Improvement Activities (15 percent). Cost would continue to be weighted at 0 percent in 2018.
  • The low-volume threshold for MIPS would be increased from less than or equal to $30,000 in Medicare Part B allowed charges or 100 Medicare Part B patients in 2017 to less than or equal to $90,000 in Medicare Part B allowed charges or 200 Medicare Part B patients in 2018. This would result in additional clinicians being excluded from the program.
  • In response to industry input, the CMS would expand MIPS to include a facility-based option beginning in 2018 that would allow clinicians to use their facility’s value-based purchasing program measure results.
  • The CMS would allow MIPS clinicians to continue using the 2014 edition of certified electronic health records for the 2018 performance year.
  • The CMS proposed policies for clinicians to earn incentives for participating in advanced alternative payment models (APMs).
  • The proposal also includes information regarding the All-payer Combination Option, which would use both Medicare and other payer APM (Medicare Advantage, Medicaid and commercial payers) information to calculate clinician incentives beginning in 2019.

Physicians who are employed by health systems are encouraged to review the proposed rule to understand its potential impact on health system operations and reimbursement. MHA members with questions should contact Jason Jorkasky at the MHA.

Tags: MACRA, Medicare Physician Quality Payment Program, QPP, MIPS, Merit-based Incentive Payment System

Posted in: Issues in Healthcare, Member News

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