The proposed rule for MACRA and the Merit-based Incentive Payment System (MIPS) program was released June 21, 2017. As expected, the program requiring the implementation of the new MIPS scoring system and incentives to move to alternative payment models (APMs) will continue.

This proposed rule represents a modification of the 2018 requirements as the program is phased in over a period of 4 years. The Department of Health and Human Services has limited ability to change the requirements of the program. The modifications in the proposed rule for 2018 are felt to fit within the framework of the legislation. Penalties and bonuses in the program were set by the MACRA legislation that fixed the sustainable growth rate and required the implementation of the MIPS program for traditional Medicare while providing additional money for growth of APMs. In this article, we will focus on the proposed rule’s effect on MIPS.

Recall that the MIPS program introduced last year included four categories, each of which made up a percentage of the final score for the program. The four categories that make up the MIPS score include Quality (formerly the Physician Quality Reimbursement System), Improvement Activities, Advancing Care Information (formerly Meaningful Use), and Cost (formerly the value-based modifier).

The data for each of the MIPS year are collected 2 years prior to the implementation of the bonus or penalty. For example, data submitted for 2017 will impact payments for the 2019 payment year.

Cost category delayed for 1 more year

For 2018, the Centers for Medicare & Medicaid Services is proposing to delay for 1 more year the inclusion of the Cost portion of the MIPS program. The proposed rule does not include the options of limited participation that were allowed in 2017; instead, reporting periods for each of the categories are as follows: Quality: 12 months; Improvement Activities: 90 days; Advancing Care Information: 90 days; and Cost: Not required.

The proposed rule included a change in the lower threshold for those required to participate in the MIPS program. For 2018, those physicians with equal to or less than $90,000 in traditional Medicare reimbursements (Medicare Advantage patients are not counted in the calculation) or equal to or less than 200 patients in traditional Medicare are excluded from reporting requirements for MIPS.

Quality. The proposed rule offered no significant changes to the Quality category for reporting during 2018. Options to report as an individual or a group remain. Six measures can be reported for individuals electing to report, with a maximum 10 points per measure. The Group Practice Reporting Option must again be elected by a group and require that a group sign up for the group reporting option. (If you intend to report as a group, you will need to monitor the sign-up deadlines put forth in the final rule once released).

Source: Adapted from the Centers for Medicare & Medicaid Services information by Ray Painter MD and Mark Painter

Reporting methods remain the same. CMS has reserved the right to remove measures from the final rule based on the number of providers successfully reporting the measures. CMS may also add measures to the list if they are approved. Final measures and reporting methods allowed for each measure will be released with the final rule by Nov. 1, 2017.

Carefully review the measures available and method of reporting when the final rule is released. The method of reporting each measure and the measures projected to be reported by urologists are included in a table.

Improvement Activities. The 90-day reporting period for Clinical Practice Improvement Activities will be reported to CMS via attestation for 2018, with no changes from current-year scoring. We encourage you to to review our previous articles (www.urologytimes.com/urology-coding) about MIPS for further information on this category.

Advancing Care Information. One of the bigger moves within the proposed rule is the slowing of EHR certification requirements. This move appears to reflect a reaction to industry feedback. The proposed rule allows physician offices to continue to use systems certified to 2014 to qualify for the Advancing Care Information category. Those who are using 2015 certified technology will be awarded bonus points for the category in a nod to continuing to push the industry toward the development of interoperability.

There is a proposed change in scoring requiring e-prescribing and security measures to be attested to but are awarded 0 points. Other scoring adjustments will require broader use of the EHR technology to score higher.

CMS is proposing to allow virtual groups to form to leverage purchasing power to lower costs using technology, information technology assistance, and consulting services. Groups of 10 or fewer physicians will be allowed to become reporting groups without changing their tax ID. This new proposal sounds promising and will be explored further by many groups. We intend to provide more information on this option as we study it in more detail.

Conclusion

The 2017 option to report over a limited period leading up to 2018 and the further phase-in of the program next year lead us to recommend that eligible providers and groups that have not yet geared up to participate in the MIPS program start now. It is not too late. In fact, a strategy that targets a Q4 implementation of data participation in the three categories of Quality, Improvement Activities, and Advancing Care Information will allow the group to potentially qualify for bonus payments in both 2019 and 2020. Additionally, groups that at least report something in Q4 2017 will get an idea of how well they are complying to each selected reporting activity in time to make some changes in 2018 to increase the potential of success with MIPS for 2020.