By Beth Hickerson, Quality Improvement Advisor, Medical Advantage Group

Almost a year ago, Congress established the Quality Payment Program (QPP) under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). While designed to improve patient health outcomes, encourage practices to spend wisely, minimize the burden of practice participation, and be fair and transparent, the program has been difficult for many medical practices to implement.

The government recently announced 2018 changes to this program. But don’t be dismayed. Many of these changes add flexibility and higher exemption requirements—welcome news to medical practices.

Medical practices will be most affected by changes made by the Centers for Medicare and Medicaid Services (CMS) to the Merit-Based Incentive Payment System (MIPS), one of two QPP tracks. Some of the major changes to MIPS that practices should be aware of are:

1. Category weights have changed, even though the four reporting categories and requirements remain the same:
• Quality: 50 percent
• Advancing Care Information: 25 percent
• Improvement Activities: 15 percent
• Cost: 10 percent
2. Important general MIPS changes/updates include:
• Performance threshold to avoid penalties increased from 3 points to 15 points.
• Virtual groups participation option offered.
• Low-volume threshold increased. More small practices and eligible clinicians in rural and Health Professional Shortage Areas (HPSAs) are exempt from MIPS participation.
• 2017 threshold:
• 2018 threshold:
• Five bonus points added to the final score of clinicians in small practices.
• Up to five points added to the MIPS final score for providers caring for complex patients.
• Extreme and Uncontrollable Circumstances provision added for providers impacted by natural disasters.
3. MIPS Quality category changes have taken place:
• Quality reporting period increased to 12 months.
• MIPS performance improvement incorporated in scoring quality performance.
• Data completeness standards increased to 60 percent.
• Minimum scoring on measures that do not meet case minimum standards reduced to one point for large practices (16 or more providers).
• Caps on scoring limits on “topped-out” measures have changed. Six “topped-out” measures have been given a cap of seven performance points, rather than 10.
4. MIPS Advancing Care Information category changes have occurred:
• Incentives added to encourage the use of 2015 edition Certified Electronic Health Record Technology (CEHRT).
• Exclusions added for the E-prescribing and Health Information Exchange base measures.
• New Advancing Care Information hardship exception added for clinicians in small practices.
• New Advancing Care Information hardship exception option added for clinicians whose EHR was decertified.
• Automatic re-weighting of the Advancing Care Information performance category score to Quality added for ambulatory surgical center (ASC)-based MIPS eligible clinicians.
5. MIPS Improvement Activities category changes have been made:
• Total number of approved Improvement Activities increased from 92 in 2017 to 112 in 2018.
• Additional CEHRT-related Improvement Activities made available.
• Patient-Centered Medical Home (PCMH) certification threshold changed for full Improvement Activities credit.
6. MIPS Cost category changes have occurred:
• Episode-based measures eliminated from the Cost category score calculation.
• Automatic re-weighting of Cost score to Quality added for clinicians who do not meet minimum case standards requirements.
• Improvement scoring added for Cost.

Practices that find these changes overwhelming may want to reach out for expert help with industry-leading best practices to maximize Medicare payments—visit medicaladvantagegroup.com for more information. For resources on MACRA and being successful in optimizing reimbursement, go to thedoctors.com/MACRA.

Contributed by The Doctors Company (thedoctors.com)