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CMS Proposes Changes to the Quality Payment Program for 2018

June 23, 2017

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Gayle Lee, Director, Physician Payment & Quality

The Centers for Medicare and Medicaid Services (CMS) June 20 released a proposed rule that would make changes to the Quality Payment Program under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA, P.L. 114-10) for 2018. In the rule, CMS includes a number of provisions that address concerns raised by the AAMC and other physician groups that would alleviate burden.

Key proposals from CMS include:

  • Increasing the low volume threshold to exempt more clinicians in small practices from participation in the program;
  • Continuing to allow the use of 2014 Edition CEHRT (Certified Electronic Health Record Technology) in year two of the program;
  • Adding bonus points to the scored for eligible clinicians for caring for complex patients;
  • Rewarding eligible clinicians for performance improvement under the merit-based incentive payment system (MIPS) through changes to the scoring method;
  • Allowing facility-based scoring for facility-based clinicians based on the Hospital Value Based Purchasing Program;
  • Extending the 0 percent weight of the cost performance category in the 2020 MIPS payment year. For 2021 and beyond, the weight of the cost category would be increased to 30 percent;
  • Providing more detail on how eligible clinicians in Alternative Payment Models (APMs) will be assessed under the APM scoring standard;
  • Adding a fourth snapshot date of Dec. 31 for the purpose of determining participating in full taxpayer identification number (TIN) MIPS APMs;
  • Giving more detail on how the All-Payer Combination option used to determine whether eligible clinicians meet the threshold to be qualified participants in an Advanced APM is calculated; and
  • Exempting Round 1 participants in the Comprehensive Primary Care Plus Model (CPC+) from the requirement that the medical home standard applies only to APM entities with fewer than 50 clinicians in their parent organization.

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