CMS Releases Quality Payment Program Proposed Rule

July 2017 ~

On June 20th CMS released its 2018 Medicare Quality Payment Program (QPP) proposed rule. Officially titled, “CY 2018 Updates to the Quality Payment Program,” the rule includes key policy updates that seek to streamline reporting requirements and simplify participation under the Merit-Based Incentive Payment System (MIPS) [Track 1] and the Advanced Alternative Payment Model (Advanced APM) [Track 2] pathways created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

CMS is hopeful that the special policies established for year two of the program will increase successful participation rates as well as reduce provider burden, and offer aid providers in preparing for the calendar year (CY) 2019 and will in turn encourage more providers to participate in the program moving forward.

Key policy updates to the QPP for 2018 include:

  • Increasing the low-volume threshold 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;
  • Implementation of virtual groups, allowing small groups and solo practitioners under two or more taxpayer identification numbers to participate in MIPS as a single group for both 2018 and 2019;
  • Implementation of facility-based measures in MIPS to allow clinicians to be assessed based on their facility’s performance;
  • Continued recognition of qualified clinical data registries such as the NCDR PINNACLE Registry and the Diabetes Collaborative Registry as MIPS data reporting options;
  • Maintenance of the nominal risk and qualifying participant thresholds for the Advanced APM pathway;
  • Implementation of the ‘All-Payer Combination Option’ for the Advanced APM pathway starting in the 2019 performance year;
  • Adjustments to MIPS Weighting for 2018 Performance Year/2020 Payment Year:
    • Maintain 60% weight for Quality
    • Maintain 15% weight for Improvement Activities
    • Maintain 25% weight for Advancing Care Information; clinicians can use 2014 or 2015 certified electronic health record technology (CEHRT), with a bonus for using 2015 CEHRT
    • Maintain zero weight for Cost

Based on 2018 performance, clinicians and groups will be eligible to receive up to +/- 5 percent in bonuses or penalties on Medicare Part B services provided in 2020 under MIPS. Qualifying participants in an Advanced APM will be eligible to receive a five percent lump sum bonus

For more details about the QPP proposed rule, refer to the CMS fact sheet.


Source(s): Deloitte Center for Health Solutions; ACC; AHA News Now; Federal Register;CMS;