2018 Quality Payment Program (MACRA) Proposed Rule: A Focus on Flexibility and Gradual Transition in Year 2

On June 20, 2017, the Centers for Medicare and Medicaid Services (CMS) posted the 2018 Quality Payment Program (QPP) Proposed Rule (CMS-5522-P). Established through the Medicare Access and CHIP Reauthorization Act (MACRA), the QPP includes two tracks for Medicare physician payment under Part B: the Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs).

The physician community and other stakeholders have eagerly awaited this year’s QPP Proposed Rule because of the expectation that the new Administration would put its mark on implementation with significant changes. While the new Administration’s fingerprints are obvious and plentiful, most notably through new relief targeting solo practitioners and rural and small practice groups, the proposed updates continue the current implementation path of transition to value-based care, and do not significantly alter the trajectory that was set in 2017.

For 2017, the first year of the program, CMS implemented the “Pick Your Pace” approach that allowed clinicians to select their level of participation and gradually ease into the program requirements. Under this transition, clinicians are able to avoid a negative payment adjustment by submitting even a minimal amount of data.

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