MACRA: Jaw-Dropping Updates for the 2018 Performance Year Part 1

Renae Rossow
Aug 9, 2017 · 3 min read

The “Proposed” Rule for the 2018 Performance Year of MACRA’s Quality Payment Program (QPP) has been released and some of the updates might make your jaw drop. The next few articles in this series will review and explain the updates that could go into effect for next year.

In September of 2016 an enormous sigh of relief swept the healthcare industry when CMS announced that the 2017 performance year was to be considered a “transition year,” which would allow eligible clinicians to pick their own pace. It was a considerable step on the brakes to slow down the beginning of the QPP in order to allow more time for clinicians to get ready. However, the end result is still the same. Small and rural practices are struggling to get ready. The great news is that CMS understands this and is making further changes to accommodate small practices in the next performance year.

Let’s begin breaking down the updates.

Virtual Groups

The second Performance Year brings the introduction of Virtual Groups. In short, these groups are for solo practitioners and groups of 10 or fewer eligible clinicians that are in the MIPS payment track. It would work the same way a true group practice works except the clinicians would come together virtually to report. It requires at least an eligible clinician to come together with at least one other eligible clinician or a group of eligible clinicians for a full one-year performance period. It will not matter where the practitioners are located but only that they come together and meet the same measures and performance category requirements as non-virtual MIPS groups.

What does this mean for you? If you are a small group or a single practitioner who is considered a MIPS eligible clinician you would follow these steps:

  1. Form a group with other single practitioners or groups of less than 10 eligible clinicians whose practice is similar to yours and would therefore want to report for the same, relevant quality measures.
  2. Choose six quality measures that are relevant for everyone in the group.
  3. Choose improvement activities that are agreed upon by the group.
  4. Make sure that everyone in the group is using a certified EHR that was certified in the same year so that the group may report the same for the Advancing Care Information Category.

Why would you want to form a Virtual Group? The answer is pretty simple, it will give you a better chance of performing better and ranking higher which could result in achieving a positive payment adjusting and additional bonus payments. There will be more information forthcoming that will provide step-by-step instructions for eligible clinicians to form virtual groups so stay tuned.

Low-Volume Threshold

In the 2017 Performance Year, the low volume threshold was increased so that eligible clinicians who received less than or equal to (<) $30,000 in Part B allowed charges OR treated less than or equal to (<) 100 Part B beneficiaries during the year prior to the performance year were excluded form the MIPS payment track and would not receive a negative payment adjustment. To clarify, this is an either/or rule so if either of those two determinants apply to your practice you would be excluded from MIPS.

For the 2018 Performance Year, the two low-volume thresholds could be increased to < $90,000 in Part B allowed charges or < 200 Part B beneficiaries. Additionally, it has been proposed that starting in the 2019 Performance Year, if your practice meets one of these low-volume threshold, you could still have the option to participate if you wanted to. However, you would still not be penalized if you chose to abide by the exclusion.

These are just two of the enormous updates that are being proposed for the 2018 Performance Year. Come back next week to learn about more of the changes to the QPP that will affect your practice.

Renae Rossow

Written by

Internet Marketer, Speaker, Consultant, Mom, Wife, Gigi & @hubspot enthusiast! http://conv3rted.com

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