CMS Releases Quality Payment Final Rule

The Centers for Medicare and Medicaid Services (CMS) recently released the 2018 Medicare Quality Payment Program final rule with comment period, providing participation requirements under the Merit-Based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model (Advanced APM) pathways created by the Medicare Access and CHIP Reauthorization Act (MACRA). Policies under the final rule go into effect Jan. 1, 2018.

Some key points from the rule include:

  • The low-volume threshold was increased to less than or equal to $90,000 in Medicare Part B allowed charges or less than or equal to 200 Part B patients to allow more small practices to qualify for MIPS exemption. (In 2017, the limits were $30,000 in Medicare Part B allowed charges or less than or equal to 100 Part B patients.)
  • Addition virtual groups as an option to participate in MIPS in 2018
  • Addition of up to five bonus points for clinicians who treat complex patient populations.
  • Maintained nominal risk and qualifying participant thresholds for the Advanced APM pathway.

The MIPS category weights finalized for the 2018 Performance/2020 Payment Year are:

  • Quality: 50% (a decrease from 60% in 2017) The Society's Mastery of Breast Surgery Program has self-nominated to continue as a Qualified Clinical Data Registry (QCDR) for the 2018 reporting year.
  • Advancing Care Information: 25% Clinicians can use 2014 or 2015 certified electronic health record technology (CEHRT), with a bonus for using only 2015 CEHRT.
  • Improvement Activities: 15%
  • Cost: 10% (an increase from 0% in 2017) based on total per capita costs for all attributed beneficiaries and the Medicare Spending per Beneficiary (MSPB) measure.

Highlights of the final rule may be found in the Quality Payment Program Year 2 Fact Sheet. The Society will continue to review the final rule and provide additional information on 2018 reporting in the future.