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CMS Finalizes Changes to the Quality Payment Program for 2018

November 3, 2017—The Centers for Medicare and Medicaid Services (CMS) Nov. 2 released a final rule that will 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 [see Washington Highlights, Aug.25].

Highlights from the rule include:

  • The low volume threshold is increased to less than or equal to $90,000 in Medicare Part B allowed charges or less than or equal to 200 Medicare Part B patients to exempt more clinicians in small practices from participation in the program;
  • Clinicians will be allowed to continue using 2014 Edition CEHRT (Electronic Health Record Technology) in year two of the program, but will earn a bonus for using only 2015 Edition CEHRT in 2018;

  • Adds bonus points to the scored for eligible clinicians for caring for complex patients;

  • Rewards eligible clinicians for performance improvement under the Merit-Based Incentive Payment System (MIPS) through changes to the scoring method;

  • Allows facility-based scoring for facility-based clinicians based on the Hospital Value Based Purchasing Program;

  • Finalizes a 10 percent weight for the cost performance category in the final score in the 2020 payment year, to ease the transition to a 30 percent weight in the 2021 MIPS payment year;

  • Provides more detail on how eligible clinicians in Alternative Payment Models (APMs) will be assessed under the APM scoring standard;

  • Provides additional detail on how the All-Payer Combination option is used to determine whether eligible clinicians meet the threshold to be qualified participants in an Advanced APM is calculated;

  • Exempts 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; and

  • Adds virtual groups as a participation option for MIPS.

CMS issued a fact sheet on the final rule that 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
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Telephone: 202-903-0806