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CMS Publishes its 2018 MACRA Final Rule


Insight into CMS' 2018 MACRA final rule released earlier this week.

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.

Study: 1 in 50 Physicians to Leave Medicine within Two Years

The American Medical Association (AMA) published a study this week showing one in five physicians are likely to reduce clinical hours within the year. The study also found that one in fifty docs plan to leave medicine for a new career in the next two years. Among the reasons physicians are leaving medicine are burnout, technology dissatisfaction, and administrative fatigue, according to the study.

Following the study's release, the AMA released a statement about the ongoing physician shortage. "The AMA is urging Congress, hospitals, and health plans to recognize the coming crisis as an early warning sign of health system dysfunction. America's physicians are the canary in the coal mine," AMA President David O. Barbe, said in the statement.

The study was conducted by the AMA, Rochester, Minn.-based Mayo Clinic and Stanford University. More than 6,000 physicians took part in the study that spanned all specialties across the U.S.

Quote of the Week:

"MGMA is very disappointed that CMS quadrupled the length of the quality reporting period under MIPS from the current 90 days to 365 days in 2018. This fourfold increase to the quality reporting requirements is in stark contrast the Agency’s statements today that the final rule reduces regulatory burdens. CMS is in effect prioritizing quantity over quality and giving physicians less than 60 days to prepare for the 2018 MIPS requirements."

Anders Gilberg, Senior Vice President, MGMA Government Affairs on the MACRA final rule

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