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CMS Publishes its 2018 MACRA Final Rule

CMS Publishes its 2018 MACRA Final Rule

Welcome to Practice Rounds, our weekly column exploring what's being covered in the larger world of healthcare.

CMS Publishes Final Rule under MACRA

On Thursday, the CMS published its 2018 Quality Payment Program (QPP) final rule under Medicare Access and CHIP Reauthorization Act (MACRA). Here are some of the notable highlights from the 1,653-page rule.

•CMS is going with 365-day reporting period for Cost and Quality, much to the chagrin of many provider groups.

•For the 2018 Merit-Based Incentive Program System (MIPS) final score, the performance category weights will be: Quality – 50 percent, Cost – 10 percent, Improvement Activities — 15 percent, and Advancing Care Information (ACI) — 25 percent. This is a change from 2017, when Cost wasn't counted for and Quality was 60 percent.  

•Moreover, the newly-published rule raises the MIPS performance threshold to 15 points in year two, up from three points during the transition year.

•The rule allows for use of 2014 edition and/or 2015-certified electronic health record (CEHRT) technology in year two for the ACI performance category, but gives a bonus for using only 2015 CEHRT.

 •Physicians will be able to earn up to five bonus points on their final MIPS score for treating complex patients. Small practices, which include 15 eligible physicians or less, receive bonus points for participation overall and in various categories.

Like the proposed rule, the final rule includes guidance on "virtual groups" for solo practitioners and groups of 10 or fewer eligible clinicians. These professionals can partner with at least one other group to report MIPS quality metrics, regardless of location or specialty. Payment adjustments for virtual groups will be made at the individual level even though performance is aggregated. You must elect your virtual group by December 31st of this year for it to count.


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