Medicare finalizes 2018 payment and quality reporting changes


The Centers for Medicare & Medicaid Services (CMS) has released two final rules impacting Medicare physician payment policies and quality reporting requirements. First, CMS finalized modifications to the Merit-Based Incentive Payment System (MIPS) and alternative payment models (APMs) participation options and requirements for 2018. CMS estimates the vast majority of eligible clinicians and groups will participate in MIPS, making it the default track again in 2018.

The final rule changes MIPS in the following ways:
  • Quadruples the reporting period for the quality component of MIPS from 90 days to one calendar year;
  • Delays the mandate to move to 2015 Edition Certified EHR Technology;
  • Increases the low-volume threshold exclusion to $90,000 in Medicare Part B allowed charges or 200 Medicare Part B patients;
  • Counts the criticized cost component as 10% of the MIPS final score;
  • Provides additional flexibility for small group practices; and 
  • Offers a virtual group option for solo practitioner and small practices to aggregate their data for shared MIPS evaluation.
Additionally, CMS released the 2018 Medicare Physician Fee Schedule (PFS) final rule. Among other changes, the final rule:
  • Sets the CY 2018 PFS conversion factor at $35.9996 and the CY 2018 national average anesthesia conversion factor at $22.1887, both of which reflect a modest payment increase under the Medicare Access and CHIP Reauthorization Act (MACRA). 
  • Delays mandatory appropriate use criteria consultation until Jan. 1, 2020;
  • Retroactively lowers PQRS reporting requirements to six measures; 
  • Reduces Value-Based Payment Modifier penalties and holds groups harmless if they met minimum quality reporting requirements; and
  • Establishes the new Medicare Diabetes Prevention Program, which begins April 1.