The Good and Bad of the 2018 MACRA Proposed Rule

On Tuesday, CMS issued the proposed rule for the 2018 performance year of the Quality Payment Program (QPP) under the Medicare Access and CHIP Reauthorization (MACRA) Act.For small practices, it should be seen as a major win, early observers of the rule say. CMS created flexibilities in the QPP that will allow practices with 1 to 15 physicians (its definition of small) to either skip participation altogether or have an easier time adhering to the guidelines.Here are the key things to know about the changes in the proposed rule for the 2018 performance period.CMS proposed raising the low-volume threshold for the Merit-based Incentive Payment System (MIPS) from $30,000 in Medicare Part B allowed charges or fewer than 100 Part B beneficiaries to $90,000 in Part B allowed charges or fewer than 200 Part B beneficiaries.The rule includes the option for providers to band together and report in Virtual Groups.CMS proposed adding bonus points to the MIPS scoring methodology for small practices.The weights of the measures that contribute to the MIPS composite score were adjusted and the threshold to participate without receiving a penalty remains low.The amount of Medicare Part A and B revenue that must be at risk to qualify as an advanced Alternative Payment Model was extended for two years.The Medical Group Management Association (MGMA) sees positives and negatives in the proposed rule, says to its senior vice president of government affairs, Anders Gilberg. Positives include the rule's delay of the move toward more restrictive EHR certifications, CMS keeping the cost component at zero for another year, and the expansion of the low-volume threshold. Some aspects of the proposed rule the MGMA does not support include the MIPS formula still being too complex, data reporting for quality being adjusted to a full year, and CMS' lack of feedback mechanisms.The slideshow above includes more reaction and analysis of the proposed rule from experts.