On November 2, 2017, the Centers for Medicare & Medicaid Services (CMS) issued the 2018 final rule for the Quality Payment Program (QPP) created under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Under the QPP, healthcare providers are rewarded for improved outcomes and value either through the Merit-Based Incentive Payment System (MIPS) or the Advanced Alternative Payment Model (APM). For the program’s second year, CMS introduced several MACRA changes, including the 10 summarized below.

  1. Increased emphasis on cost of care: The MACRA measures of quality and cost performance were reweighted so clinicians’ final scores will be based as follows: 50 percent quality, 10 percent cost, 15 percent improvement activities and 25 percent advancing care information.
  2. Extended performance period for quality: The performance period for the quality category will be extended to a full 12 months instead of 90 days. This is one of the more significant changes to MACRA requirements.
  3. Fewer clinicians required to participate: The Final Rule MACRA and MIPS raises the low-volume threshold that exempts physicians from MIPS participation. Physicians with less than $90,000 in Medicare Part B charges and 200 patients annually are not subject to MIPS.
  4. Bonus opportunities: The MACRA update allows small practices with 15 or less physicians to earn up to five bonus points if data for at least one performance category is submitted.
  5. Bonus opportunities: Up to five bonus points are available to physicians who treat especially complex patients.
  6. Hardship exceptions: MIPS physicians affected by extreme and uncontrollable circumstances such as hurricanes can submit hardship exception applications for re-weighting of quality, cost and improvement activities categories.
  7. EHR transition delay: Providers can continue using a 2014 edition of their certified electronic health record (EHR) system to report the advancing care information MACRA measures. Clinicians that upgrade and report only with 2015 editions could get a bonus of up to 10 percent.
  8. Option to form virtual group: Solo practitioners and physicians in practices of 10 or less can form virtual groups to report for MIPS. Applications must be submitted by December 1.
  9. Increased performance threshold: To avoid MIPS payment penalties in 2020, providers must obtain a minimum of 15 points in 2018, up from three points in 2017.
  10. More providers qualify for APM: Nearly twice as many practitioners are expected to qualify for participation in an APM in 2018.