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MACRA/MIPS FINAL RULE HIGHLIGHTS 2017-2018

The Centers for Medicare and Medicaid Services (CMS) released a final rule for MACRA 2018 that focuses on alleviating the burden on EC’s and clarifying the policies related to the Quality Payment Program. The rule attempts to make things easier for smaller, independent, and rural practices.

The final rule includes some changes that mean fewer EC’s will be required to participate. The law, the Medicare Access and CHIP reauthorization Act of 2015, known as MACRA created the payment Quality Payment Program (QPP). The QPP reimburses EC’s who treat Medicare beneficiaries based on meeting quality benchmarks and the continued transition to EHR’s.

Under the QPP, EC’s can choose two tracks. One is the Merit-Based Incentive Program (MIPS) and the other is the Advanced Alternative Payment Model (APM). Most EC’s fall under MIPS.

Notable Highlights of the 2017 Transition Year and the 2018 Final Rule:

POLICY TOPIC TRANSITION YEAR 1 2017 YEAR 2 2018
Low-Volume Threshold You’re excluded if you or your group has <$30,000 in Part B allowed charges OR <100 Part B beneficiaries You’re excluded if you or your group has <$90,000 in Part B allowed charges OR <200 Part B beneficiaries
Virtual Groups Not an option Added Virtual groups as a way to participate for year 2.  Virtual groups can be made up of solo practitioners and groups of 10 or fewer eligible clinicians no matter what specialty or location
Quality Weight to final score:

  • 60% in 2019 payment year
  • 50% in 2020 payment year
  • 30% in 2021 payment year and beyond

Scoring:

  • 3 point floor for measures scored against a benchmark
  • 3 points for measures that don’t have a benchmark or meet case minimum requirements
  • Bonus for additional high priority measures up to 10% of denominator for performance category

Bonus for end to end electronic reporting up to 10% of denominator for performance Category

 Weight to final score:

  • Finalized at 50% in 2020 payment year
  • 30% in 2021 payment year and beyond

Scoring: No change
Topped Out Measures Not applicable for the transition year
  • Topped out measures will be removed and scored on 4 year phasing out timeline
  • Topped out measures with measure benchmarks that have been topped out for at least 2 consecutive years will earn up to 7 points
Cost Weight to final score:

  • 0% in 2019 payment year
 Weight to final score:

  • Finalized at 10% in 2020 payment year
  • 30% in 2021 MIPS payment year and beyond
Improvement Activities Weight to final score:

  • 15% and it is measured based on a selection of different medium and high weighted activities
 Weight to final score:

  • No change for the 2020 payment year
Advancing Care Information Weight to final score:

  • 25% made up of a base score, performance score and bonus points

CEHRT Requirements:

  • Can use 2014 or 2015 edition CEHRT for the 2017 transition year

Scoring:
Required Measures/Base Score

  • Award a base score of 50% in you submit the numerator of at least 1 and denominator, answer yes for the yes/no measures
  • Receive 0 for the Category if the Base Score is not met

Performance Score
Award points if you submit additional measures up to 10%

Bonus Score

  • Give a bonus score for submitting to 1 or more additional public health agencies or clinical data registries
  • Give 10% bonus points when you use CEHRT to complete at least 1 of the specified improvement activities
 Weight to final score:

  • No change for the 2020 payment year

CEHRT Requirements:

  • No Change for 2018 however you are able to receive a 10% bonus if you only use the 2015 Edition CEHRT

Scoring:
Required Measures/Base Score

  • No change to the base score requirements for the 2020 payment year

Performance Score

  • earn 10% for reporting to any single public health agency or clinical data registry

Bonus Score

  • 5% bonus score is available for submitting to an additional public health agency or clinical data registry not reported under the performance score
  • 10% bonus score for using 2015 CEHRT exclusively
  • Additional improvement activities eligible for a 10% bonus if you use CEHRT to complete at least 1 of the specified activities
Final Score
  • Quality 60%
  • Cost 0%
  • Improvement Activities 15%
  • Advancing Care Information 25%
  • Quality 50%
  • Cost 10%
  • Improvement Activities 15%
  • Advancing Care Information 25%
Performance Period
  • 90 days with the exception of CMS Web Interface, CAHPS and the readmission measure which are for 12 months
  • Quality and Cost are at a full year
  • ACI and IA are at 90 days
  • Exception remains the same
Exclusions
  • HIE and eRX <100
  • HIE and eRX <100

A CMS fact sheet on the final rule.

The final rule with comment.

As you evaluate this MACRA/MIPS transition year as well as future years, know the eMedApps is here for you to provide support and guidance through the many challenges of MACRA/MIPS.

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About the Author:

Christina is a Project Management and Application Specialist at eMedApps with over 20 years of experience in the Health Care industry. The Certified NextGen professional applies her clinical, IT and Quality background along with her NextGen system knowledge to aid practices in workflow enhancements, efficiency optimization, upgrades, reporting, CCM, PCMH, Meaningful Use, MIPS, quality initiatives and best practice implementation. Christina resides in Michigan and is detail orientated, organized, and has a positive can-do attitude. She thoroughly enjoys working with clients to achieve their goals.