The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule that would make changes in the second year of the Quality Payment Program as required by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

Though not perfect, the California Medical Association (CMA) is pleased that CMS has listened to physician feedback and has made changes that will significantly reduce the administrative burdens on physicians, particularly for small and rural practices. 

Under the proposed rule, 2018 will be another transition year like 2017. This means that physicians who report only one quality measure in 2018 can avoid all penalties in 2020.

MACRA repealed the fatally flawed sustainable growth rate (SGR) payment system, which governed how physicians and other clinicians were paid under Part B of the Medicare program. It replaced the SGR and its fee-for-service reimbursement model with two paths: The Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). CMS will begin measuring performance for eligible clinicians in 2017, with payments based on those results beginning in 2019.

CMS estimates that under the proposed 2018 MACRA rule, 94 percent of physicians will earn either a positive or neutral payment adjustment in 2020 for the 2018 reporting year.

Major highlights:

• Allows the creation of virtual groups to assist small practices.
• Significantly expands the low-volume threshold to $90,000 or less in Medicare Part B allowed charges OR 200 or fewer Medicare Part B patients (previously the threshold was $30,000 in allowed charges or 100 patients). CMS estimates that only 37 percent of clinicians who bill Medicare will be subject to MIPS with this larger exception.
• Provides automatic bonus points for small practices.
• Adds a hardship exemption from the electronic health records (EHR) category for small practices. 
• Provides opportunities to achieve bonus points in the EHR category, with physicians only needing to report on Stage 2 measures instead of Stage 3.
• Provides bonus points for treating complex patients, such as dual eligibles. 
• Physicians will not be scored on "resource use" (physician cost) in 2017.
• Reduces the Medicare revenue and patient threshold to qualify for APMs.

CMA will submit comments on the proposed rule and will continue to fight for improvements to the MACRA regulations to reduce administrative burdens and open up more opportunities for fair payment.

For more details on the new rule, see the CMS Fact Sheet.