The trend toward value-based payments began with the implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) that was signed into law in April 2015. Since then, there have been updates and additional programs included in MACRA, such as the Quality Payment Program (QPP). MACRA created a new framework for independent physicians who will be rewarded financially for providing high-quality care, through two tracks for payment: Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (AAPMs).
For 2018, the American Academy of Family Physicians (AAFP) lists a number of expected updates:
Small Practice and Complex Patient Bonuses: Independent physicians with smaller practices will receive a 5-point bonus on their Merit-based Incentive Payment System (MIPS) score. Eligible clinicians will also earn a bonus of up to 5 points for providing care to patients with complex conditions.
Increased Low-Volume Threshold: Eligible clinicians will be excluded from MIPS if they provided care to 200 or fewer Medicare Part B beneficiaries or if they received $90,000 or less in Medicare Part B payments.
Longer Performance Period: Independent physicians should be aware that the performance period in 2018 is a full calendar year (January 1 – December 31) for the quality and cost categories and is “any consecutive 90 days” for the advancing care information and improvement activities categories.
Data Completeness: Eligible clinicians participating in the quality category must report on at least 60% of their patients that are eligible for the measure, regardless of their payer.
Cost Will Be Scored: For the 2018 performance period, the weight of the cost category has increased to 10% and the weight of the quality category has decreased to 50%.
Virtual Groups Available: For those smaller independent physician practices, including solo practitioners and practices of 10 or fewer clinicians, the opportunity is available to join together as a virtual group in order to participate in MIPS.