CMS issues final rule for CY 2018 MACRA physician QPP

The Centers for Medicare & Medicaid Services today issued a final rule (https://s3.amazonaws.com/public-inspection.federalregister.gov/2017-24067.pdf) updating the requirements of the quality payment program for physicians and eligible clinicians mandated by the Medicare Access and CHIP Reauthorization Act of 2015. The QPP includes two tracks – the default Merit-based Incentive Payment System and advanced alternative payment models. The rule adopts key policies for the QPP’s 2018 performance period, which will affect clinician payment in 2020. Among other policies, CMS will increase the MIPS’s low-volume threshold, thereby excluding more than 540,000 eligible clinicians from the program. CMS also will implement a MIPS measurement option that allows hospital-based clinicians to use their hospital’s value-based purchasing results for the MIPS cost and quality categories. However, the agency will delay the availability of the option to the CY 2019 reporting period. CMS also will continue using a 90-day reporting period for the advancing care information category in 2018, and allow clinicians to use the 2014 edition of certified electronic health records for the ACI category. In addition, the agency adopts a number of policies related to participation in advanced APMs. This includes more detail regarding the all-payer option that, beginning in 2019, will allow clinicians to qualify for advanced APM incentives based on combined participation in alternative payment arrangements with Medicare and non-Medicare payers. This final rule continues a flexible approach to the MACRA’s physician quality payment program urged by hospitals, health systems, and the more than 500,000 employed and contracted physicians with whom they partner to deliver care. “While we believe it could be adopted in 2018, we understand CMS’s decision to eventually adopt a facility-based clinician measurement option that will allow many hospitals and clinicians to spend less time collecting data, and more time collaborating to improve care,” AHA Executive Vice President Tom Nickels said in a statement. “While we applaud CMS for providing much-needed relief from unrealistic and unfunded mandates for EHR capabilities for clinicians, we are disappointed the agency has yet to provide similar relief for hospitals. We also urge CMS to provide additional avenues for clinicians to earn incentives for partnering with hospitals to provide better quality, more efficient care through advanced alternative payment models. America’s hospitals will continue to advocate for policies that align all parts of the health care systems around better care for the patients and communities we serve.” 

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