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CMS Proposes Changes to the Quality Payment Program for 2018

June 23, 2017—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.

The AAMC is analyzing the provisions of the proposed rule and will submit comments to CMS by the August 18 deadline. A CMS fact sheet on the proposed rule provides more details.


Gayle Lee
Director, Physician Payment & Quality
Telephone: 202-741-6429


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Washington Highlights, a weekly electronic newsletter, features brief updates on the latest legislative and regulatory activities affecting medical schools and teaching hospitals.

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Jason Kleinman
Sr. Legislative Analyst, Govt. Relations
Telephone: 202-903-0806