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Second Opinion

Learn about policy issues important to medical schools and teaching hospitals, with Executive Vice President Atul Grover, M.D., Ph.D.

Washington Highlights

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.

Contact:

Gayle Lee
Director, Regulatory Counsel
Telephone: 202-741-6429
Email: galee@aamc.org

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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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For More Information

Jason Kleinman
Sr. Legislative Analyst, Govt. Relations
Telephone: 202-903-0806
Email: jkleinman@aamc.org