Advocacy in Action - What’s in the FY2018 MIPS and APM Proposed Rule

Carter L. Alleman, J.D.

The Centers for Medicare & Medicaid Services (CMS) released the proposed rule for the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). Collectively, these programs are part of what CMS calls the Quality Payment Program (QPP). CMS has also issued a fact sheet, for a quicker summary than the 1,000 page rule.

The following is a breakdown of possible changes for the FY2018 Program year.

1. CMS has increased the low-volume threshold exclusion.
   •    Small practices, individuals or groups with fewer than $90,000 in Part B charges or 200 Part B patients (up from $30,000 and 100 patients this year) will be excluded from MIPS in 2018.
2. “Pick your pace” will continue in 2018.
   •    CMS’ 2017 “pick your pace” policy for MIPS, which allows clinicians to report a minimum amount of data to avoid MIPS penalties and ease into the program, will continue in 2018 with some important revisions.  
   •    Scoring for the quality category retains the three-point floor imposed in 2017 (out of 10 possible points), while the overall MIPS performance threshold, or benchmark, will increase from three to 15 (out of a possible 100 points.)
3. Providers can now participate in MIPS as individuals, groups, or virtual groups.
   •    As a new reporting option in 2018, CMS will allow solo practitioners and groups with 10 or fewer eligible clinicians to join together “virtually” to participate in MIPS as a Virtual Group.  
   •    In 2018 the new reporting option may be an attractive choice for smaller practices.  The proposed regulations would require providers to elect to participate in a virtual group prior to the start of the 2018 performance period, but would not restrict the formation of virtual groups by size or geography.
4. Hospital-based physicians can now report at a facility level.
   •    Hospital-based clinicians in the 2018 MIPS performance period now have an opportunity to be assessed on quality and cost in the context of the facilities where they work. Such clinicians can submit their facility's inpatient value-based score to help calculate an individual score.
5. Cost will remain 0% of the overall MIPS score in 2018. 
6. Use of a 2015 certified EHR is now optional for MIPS participants in 2018.
   •    CMS will allow MIPS-eligible clinicians to use either 2014 or 2015 Edition certified EHRs (CEHRT) for MIPS’ Advancing Care Information (ACI) category in 2018.  As an incentive to still make the change next year, providers who do use the 2015 Edition would receive a 10 percent ACI bonus.  Meanwhile, CMS also proposed a 90-day reporting period for ACI for both 2018 and 2019, which would allow providers to delay moving to the 2015 Edition until October 2019 to comply with the final 90-day reporting period that year.
7. CMS will allow multiple submission mechanisms within the ACI, quality, and improvement activities categories.
   •    In 2018, CMS will allow individual MIPS-eligible clinicians and groups to submit measures and activities through multiple submission mechanisms (as available) within a performance category to meet the requirements of the quality, improvement activities, or ACI performance categories.
8. CMS will offer small practices a “significant hardship” exception to opt out of MIPS ACI starting in 2018.
   •    Under the 21st Century Cures Act, CMS will offer practices with 15 or fewer clinicians a new category of hardship exception to reweight the ACI performance category to zero and shift the ACI scoring weight of 25% to the quality category.  Starting in 2018 a clinician could apply for the exception, if “there are overwhelming barriers that prevent the MIPS-eligible clinician from complying with the requirements” for ACI.
9. CMS made only minor tweaks to the Advanced APM regulations.
   
   

The ACOS will be submitting comments on the proposed rule in August. If you have any comments or concerns please do not hesitate to contact the ACOS at [email protected].