MACRA 2018 Final Rule Summary

Read about the MACRA Final Rule, including MIPS, and the impact it can have on your quality reporting.
Clinical Operations Value-Based Care

What is the MACRA 2018 Final Rule?

CMS announced the highly anticipated 2018 Quality Payment Program (QPP) final rule on Nov. 2, outlining requirements for the second year of MACRA. The MACRA 2018 final rule contains some key changes affecting the clinicians and medical practices participating in the new payment system, including:

  • Extending the quality reporting period under MIPS from 90 days to a full 12 months
  • Increasing the “low-volume” threshold for MIPS to exclude individual clinicians or groups with incomes of $90,000 or less in Part B-allowed charges or 200 or fewer Medicare Part B beneficiaries
  • Allowing a “hardship” exemption for certain reporting categories for small practices and clinicians impacted by natural disasters, including Hurricanes Harvey and Irma
  • Raising the weight of the Cost category in MIPS from 0% to 10%. Cost was not expected to be part of the provider performance calculation until 2019.
  • Allowing individual clinicians or clinician groups of 10 or fewer that meet the low-volume threshold to form virtual groups to report on MIPS measures

The agency said it will continue to provide flexibility, offer more incentives and help reduce the burden for clinicians and medical groups participating in the new payment system. But Anders Gilberg, Senior Vice President, Government Affairs for the Medical Group Management Association (MGMA) said he was disappointed in some of the rule’s measures.

“The final rule quadruples the 2018 reporting period for the quality component of MIPS, and we see that as a significant increase in the regulatory burden,” he said. “The majority of physicians and medical practices don’t see the clinical relevance of the program, so this just ramps it up without fixing the underlying problems.”

Gilberg said that he’s glad to see that CMS won’t require the use of 2015-certified electronic health record technology (CEHRT) and will still allow clinicians and medical practices to use the 2014 edition next year. But that doesn’t mean reporting will be easy, he says, and MIPS participants will have to wait for reports and feedback about their performances.

“In 2018, if you’re using an EHR or registry to report quality data, you have to submit data on every single patient to Medicare. That’s a lot of data to report to the government, and you won’t receive feedback on how you did until 18 months later.”

The entire MACRA final rule summary and dates can be found below:


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