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CMS Proposes CY 2018 Updates to Quality Payment Program

The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule that includes updates for the second year of the Quality Payment Program (QPP) — the physician payment system required by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

The QPP combines and replaces three separate clinician quality related programs with a single system for clinicians that bill Medicare Part B. Under the program, eligible clinicians participate in one of two tracks: the default merit-based incentive payment system (MIPS) or Advanced Alternative Payment Models (APMs). The QPP’s first performance period began on Jan. 1 and ends on Dec. 31, 2017. The first payment adjustments based on performance go into effect on Jan. 1, 2019.

For year two — calendar year 2018 — CMS proposes to amend some existing requirements and provide new policies allowing clinicians to choose how to participate in either the MIPS or Advanced APM tracks, based on their practice size, specialty, location, or patient population. In particular, CMS proposes:

  • offering a virtual groups participation option for MIPS-eligible clinicians;
  • increasing the low-volume threshold to allow more small practices to be exempt from MIPS;
  • adding bonus points to the MIPS scoring methodology for clinicians caring for complex patients;
  • asking for comment on including dual eligibility as a method of adjusting MIPS scores;
  • allowing flexibility in MIPS measure submission mechanisms;
  • providing methodology to remove topped-out quality measures from the program;
  • updating weights for the four performance categories (quality, cost, improvement activities, and advancing care information);
  • implementing a voluntary facility-based measurement option (based on the Hospital Value-Based Purchasing Program) for clinicians who provide at least 75 percent of covered services in the inpatient hospital setting or emergency department; and
  • providing more detail about future implementation in performance year 2019 of the All-Payer Combination Option, as well as the Other Payer Advanced APM option.

The proposed rule will be published June 30 in the Federal Register, with comments due by Aug. 21. America’s Essential Hospitals will provide a more detailed summary to members in the coming days.

CMS will hold a webinar on the QPP year 2 proposed rule on June 26 at 1 pm ET.

Contact Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127 with questions.

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About the Author

Maryellen Guinan is a senior policy analyst at America's Essential Hospitals.