The 2018 final rule from the Centers for Medicare and Medicaid Services on MACRA and MIPS was issued in early November, and the second-year changes show that CMS is still gearing up for flexibility and a more comprehensive program. Providers won’t see a full implementation of MACRA in 2018; that’s still planned for 2019, which is a positive for many clinicians and practices/facilities. In short, it seems that CMS is using the second year to allow for continued flexibility as providers adjust to the programs, but it is continuing the ramp-up to better ensure everyone is ready in 2019.

Here are a few of the notable MACRA changes providers may need to consider further as they prepare.

A Higher MIPS Exemption Threshold

In the final rule for MACRA and MIPS, CMS upped the threshold for physicians that would fall within the program’s scope. Previously, CMS had set the threshold so that physicians were exempt if they treated less than 100 Medicare Part B beneficiaries each year or billed Medicare Part B less than $30,000 per year. After responses from the health care community, the MACRA changes bring that threshold to 200 Medicare Part B patients each year or $90,000 in relevant billings. This lets small practices avoid some of the factors relevant to the programs, which might be difficult to measure or implement in such environments. Small practices that don’t fall under the threshold do get some consideration; they’ll receive five bonus points on their total MIPs.

Virtual Groups Are Allowed for MACRA Measures Reporting

In 2018, physicians will be allowed to group themselves virtually, despite their specialties or geo locations for the purposes of reporting MIPS measures. Every physician in the grouping does have to meet or exceed the threshold for the low-volume exemption as detailed above, though. Grouping can’t be used as a way for a provider to piggy-back into the program. This is the first year virtual groups will be allowed.

Treatment of Medically Complex Cases Receive Consideration

CMS will award up to five bonus points for clinicians who treat medically complex patients. This helps offset any disadvantages that might come from those scenarios.
These are just some of the MACRA changes that could be relevant to providers, so it’s important to for organizations, clinicians and practices to take time for understanding MACRA before 2018.