For the second year of the quality payment program under MACRA, cost performance will form 10 percent of the merit-based incentive system score in how clinicians are paid.
Quality performance will comprise 50 percent of the MIPS score, compared to 60 percent last year, according to the Centers for Medicare and Medicaid Services final rule released late Thursday.
For year 2, CMS is adding flexibility in allowing virtual provisions as a MIPS participation option.
CMS listened to stakeholder feedback in its final rule for year 2, the agency said. It is continuing to offer flexibility, especially to small practices, but is ramping up for future years in the payment program established under the Medicare Access and CHIP Reauthorization Act.
For instance a 10 percent weight in the cost performance category is to ease the transition to a 30 percent weight for the cost of care in 2021, CMS said.
"In this final rule with comment period, we continue the slow ramp-up of the Quality Payment Program by establishing special policies for MIPS Year 2 aimed at encouraging successful participation in the program while reducing burden, reducing the number of clinicians required to participate, and preparing clinicians for the CY 2019 performance period," CMS said.
CMS said it is trying to prepare clinicians for a more robust program in year 3 and for participation in APMs.
It has lengthened the MIPS quality reporting period from 90 days to one year.
The Medical Group Management Association said this rule is in stark contract to CMS saying it wants to reduce regulatory burdens.
"MGMA is very disappointed that CMS quadrupled the length of the quality reporting period under MIPS from the current 90 days to 365 days in 2018," said Anders Gilberg, senior vice president of MGMA governmental affairs. "CMS is in effect prioritizing quantity over quality and giving physicians less than 60 days to prepare for the 2018 MIPS requirements."
To be considered an Advanced APM in 2018, the APM must use certified electronic health record technology, provide for payment for covered professional services based on quality measures comparable to those in the quality performance category under MIPS and bear risk for monetary losses.
Small practices get a break, but one not as big as in year 1.
Many small practices that had a low volume of patients did not have to participate in MIPS during the first year in 2017. The low volume threshold was set at less than $30,000 in Medicare Part B charges, or equal to 100 Medicare Part B patients.
In year 2 for 2018, the low-volume threshold increases to $90,000, or equal to 200 Medicare Part B patients.
Small practices will get a bonus for using only 2015 certified electronic health record technology.
It will award small practices up to 5 bonus points on their MIPS final score for treatment of complex patients.
CMS is also adding a hardship exception for clinicians in small practices from the advancing care information performance category. This provides 3 points even if small practices submit quality measures below data completeness standards.
Clinicians impacted by Hurricanes Irma, Harvey and Maria and other natural disasters are getting a break in getting a zero percent weight in the scoring categories of quality, advancing care information and improvement activities. They can be automatically exempt from these categories without submitting a hardship exception application.