Ask the Experts

What's Next for MACRA'S Quality Payment Program?


Posted by Anonymous at 11/30/2017 8:16:03 AM

New Merritt Hawkins White Paper On MACRA Now Available


What's Next for MACRA'S Quality Payment Program?

 By Phillip Miller

Rome was not built in a day, and the same applies to MACRA’s new Quality Payment Program (QPP).


CMS issued the 2018 Final Rule for QPP in early November, modifying the program which will achieve full implementation in 2019. In that year, physicians participating in the program will get bonuses or cuts (or no adjustment) to their Medicare payments based on their performance in 2017.


The 2018 Final Rule makes several changes to the Merit-Based Incentive Program (MIPS). It reweights the four performance categories, with quality counting for 50% of performance, improvement activities 15%, advancing care information 25% and cost 10% (up from the original weight of 0%). The weights will change again in 2019.


The 2018 Final Rule also expands the low-volume threshold. Previously, physicians were exempt from MIPS if they billed less than $30,000 to Medicare Part B or treated fewer than 100 Part B beneficiaries annually. The new threshold is less than $90,000 in Part B billings and 200 Medicare patients annually. This will exempt many physicians from MIPS, but hundreds of thousands will still be required to participate or face penalties. In 2018, the minimum MIPS score required to avoid payment cuts in 2020 will be 15, up from three in 2017.


The American Hospital Association (AHA) has expressed interest in QPP because of the increased number of hospital employed physicians. In 2014, there were 249,000 physicians directly employed by hospitals, according to the AHA, and 289,000 individual or group-based with contractual agreements with hospitals.


Hospitals will be responsible for the cost and administration of MIPS for the physicians they employ, including hospital-based physicians such as anesthesiologists and emergency physicians. Hospitals also will realize any bonuses or losses resulting from MIPS performance adjustments related to employed physicians. This includes critical access hospitals (CAHs) where MIPS will apply to physicians and other clinicians who have assigned their billing rights to the CAH.


By contrast, physicians employed by Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs) are exempt from MIPS provided they participate in the FQHC/RHC payment system. This is likely to make FQHCs and RHCs more attractive to physicians and enhance their chances of recruiting successfully.


Merritt Hawkins has completed a white paper regarding QPP entitled MACRA – An Evolving Medicare Reimbursement Method for Physicians that offers more detail regarding this important payment system that will further drive healthcare payments toward value-based models. I would be happy to forward a copy of this resource to readers and to hear your thoughts about QPP.




Phillip Miller is Vice President of Communication for Merritt Hawkins and Staff Care, companies of AMN Healthcare. He can be reached here.


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