As the Quality
Payment Program approaches its second year in 2018, the Centers for Medicare
& Medicaid Services (CMS) are proposing several changes and updates in an
effort to improve patient outcomes, increase coordination of patient care,
reduce the burden on small and rural practices, while increasing participation
and program flexibility. The goal is to keep what is working with the program
and use clinician feedback to improve policies.
A few of the changes proposed
by CMS are as follows:
- Increasing the performance period to
90-days of data for the Improvement Activities and Advancing Care Information
- Offering the Virtual Groups participation
option. Virtual Groups. CMS defines a virtual group as two or more practices
with 10 or fewer providers each that combine their performance for the full
year reporting period. This option allows providers who are MIPS-exempt to
participate in MIPS through their Virtual Group and receive bonus payments.
- Increasing the low-volume threshold to
ensure more small practices and eligible providers in rural areas are exempt
from MIPS participation. CMS proposed raising the threshold from 100 to 200
Medicare Part B beneficiaries, and from $30,000 to $90,000 in Medicare Part B
- CMS will continue to allow 2014 Edition
CEHRT (Certified Electronic Health Record Technology) while encouraging the use
of 2015 edition CEHRT.
- New bonus points will be added to the
scoring methodology for:
for complex patients
2015 Edition CEHRT exclusively
- Incorporating MIPS performance improvement
in scoring quality performance.
- Implementing the option to use
facility-based scoring for facility-based clinicians.
CMS is proposing more
flexible options for providers in small practices that would:
- Add a new exception for providers in small
practices under the Advancing Care Information performance category.
- Add bonus points for providers in small
- Continue to award small practices 3 points
for measures in the Quality performance category that don’t meet data
CMS is also proposing
the following changes and updates:
- Extending the revenue-based nominal amount
standard through 2020. This allows an APM to meet the financial risk criterion
to qualify as an Advanced APM if participants bear a total risk of at least 8%
of their Medicare Parts A and B revenue.
- Changing the nominal amount standard for
Medical Home Models so that the amount of total risk slowly increases annually.
- Provide more details on the All-Payer
Combination Option. This option allows providers to become Qualifying APM
Participants (QPs) through a combination of Medicare participation in Advanced
APMs and participation in Other Payer Advanced APMs. This option will be
available in 2019.
- Provide more detail on how eligible
providers participating in selected APMs will be assessed under the APM scoring
standard. This standard reduces burden for certain APMs (MIPS APMs)
participants who do not qualify as QPs, and are therefore subject to MIPS.
For more information
regarding the proposed rule for the Quality Payment Program 2018 visit: