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MACRA's Final Rule 2018: 3 Things To Know
  • Tina Colangelo
  • Nov 13 2017

Clinicians participating in the Merit-based Incentive Payment System (MIPS) probably spent the month of October collecting performance data, in hopes to avoid the four percent penalty and earn an incentive. Many may have been too busy to notice that the Centers for Medicare and Medicaid Services (CMS) had actually released the 2018 Quality Payment Program (QPP) Final Rule a day late. While MIPS 2017 has been deemed the transitional year, it was expected that CMS would up the ante in 2018, which they did, in the quality and cost categories. Clinicians can expect the bar to rise even higher, in years to come as their performance improves and patients become healthier. Here is three things to know for 2018.

For those who may not know, MIPS was developed to become increasingly demanding. It has to if it's going to reach its primary goal of delivering quality care at lower costs. This is why is 2018, the performance threshold is set at 15. In order to avoid the five percent penalty, clinicians will need to earn a score of 15 points. This will take more effort than just submitting one measure on one patient to avoid the penalty. In fact, CMS is estimating that seventy-five percent of clinicians will earn a score of over 70 in 2018. This could become problematic for practices that just avoided the penalty in 2017 because if everyone is scoring that high, it will be almost impossible to be able to keep up with them in 2019. Strategy is key to success in 2018.

In addition, clinicians need to know that the MIPS eligibility threshold has been expanded to less than or equal to $90,000 in Medicare Part B charges or 200 or fewer Medicare patients. This means that clinicians may not be eligible to participate in the second year of the program even though they may have participated in the first year of MIPS. Clinicians are encouraged to use the lookup tool located on the qpp.cms.gov website to ensure their MIPS eligibility status in 2018. Clinicians do have the ability to volunteer to report which could be helpful with perfecting strategizies for future years of the program without the penalties. 

Finally, CMS has added new quality measures in 2018. Clinicians who may not be scoring high on measures they picked for 2017 (check with your EMR or data/QCDR registry) are encouraged to review this list prior to 2018. There may be new measures that better fit your practice. Keep in mind, that topped out measures can only earn a maximum of 7 points. Clinicians may opt to re-strategize which six measures to submit for quality in 2018. 

In 2018, we not only see higher penalities and performance thresholds, we also see major competition between the clinicians who have embraced MIPS in 2017 and are performing better and the ones who haven't. Unfortunately, the resistance will show up in their scores for the world to see. With about 7 weeks left in this year, there is still time to pool your resources together, develop a MIPS strategy and be successful in 2018! 

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