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Quality & Practice

2018 Quality Payment Program Final Rule

Quality Payment Program Year 2 Policies are Gradually Preparing Clinicians for Full Implementation

On November 2, the Centers for Medicare & Medicaid Services (CMS) issued the final rule with comment for the second year of the Quality Payment Program (calendar year 2018), as required by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) as well as an interim final rule with comment. 

CMS listened to feedback from the health care community, including your Academy, and used it to inform policy making. As a result, the Year 2 final rule continues many of the flexibilities included in the transition year, while also preparing clinicians for a more robust program in Year 3.

Your Academy is diligently reviewing the new rule, and we will share more information soon.  In the meantime, below are some key “wins” for physiatry:

  • PM&R physicians who use codes 99201-99205 and 99211-99215 can now report on the Functional Outcome Assessment measure within the QPP. Your Academy has been advocating for those codes to be added to this measure for many years. 
  • Automatically weighting the Quality, Advancing Care Information, and Improvement Activities performance categories at 0% of the MIPS final score for clinicians impacted by Hurricanes Irma, Harvey and Maria and other natural disasters. If you were impacted by these natural disasters, this means you do not need to participate. When additional details are released, AAPM&R will make them available on our website. 
  • Excluding individual MIPS eligible clinicians or groups with ≤$90,000 in Part B allowed charges or ≤200 Medicare Part B beneficiaries. This will decrease the number of doctors and clinicians required to participate.

The final rule with comment further advances CMS’s goals of regulatory relief, program simplification, and state and local flexibility in the creation of innovative approaches to health care delivery.

For More Information

The Quality Payment Program final rule with comments can be downloaded from the Federal Register at: https://www.federalregister.gov/documents/2017/11/16/2017-24067/medicare-programs-cy-2018-updates-to-the-quality-payment-program-and-quality-payment-program-extreme.

For an overview of the final rule with comment, please visit: https://www.cms.gov/Medicare/Quality-Payment-Program/resource-library/QPP-Year-2-Final-Rule-Fact-Sheet.pdf.  

For an executive summary of the rule, visit: https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/QPP-Year-2-Executive-Summary.pdf