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Final Medicare MACRA Changes for 2018

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November 8, 2017

Final Medicare MACRA Changes for 2018

The Centers for Medicare & Medicaid Services (CMS) will exempt many smaller physician practices from the new law that updates payment rates and incentives, the Medicare Access and CHIP Reauthorization Act, called MACRA. For practices that are not exempt, CMS is making it easier for them to comply.

CMS recently announced final rules for 2018, the second year of implementing MACRA, which replaced the old Sustainable Growth Rate formula and now adjusts physician payments annually based on how well physicians perform in meeting quality and cost metrics. CMS made changes in the law’s Quality Payment Program and its two payment tracks:

Merit-Based Incentive Payment System (MIPS): 

  • Allow physician practices to remain exempt from MIPS if they care for 200 or fewer beneficiaries or have $90,000 or less annual Medicare revenue

  • Award extra points in the final performance scores for small practices

  • Award extra points for practices treating complex patients

  • Provide additional performance points to physicians consulting appropriate use criteria when they use advanced diagnostic imaging

  • Allow small practices to form virtual groups to participate with other practices

  • Allow practices to adopt EHR technology at a slower pace

  • Award performance points to small practices even if they do not meet requirements for completeness of quality data

Advanced Alternative Payment Models (AAPMs):

  • Extend for two more years—rather than increase—the current level of financial risk that alternative payment models and their participating physicians must assume

  • Slow down the increase in the amount of total financial risk that medical homes must assume

  • Make it easier for physicians to quality for incentive payments by participating in alternative payment models that begin or end in the middle of the year


CMS fact sheet:  Quality Payment Program, Year 2

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