Advocacy Update

Nov. 16, 2017: Advocacy spotlight on 2018 another transition year for Quality Payment Program


As Medicare moves to the second year of its Quality Payment Program (QPP), 2018 will largely serve as another transition period. Most physicians and other health professionals who bill Medicare won't have to participate in 2018 and hardly any are projected to receive a penalty that will affect their payment in 2020.

In the 2018 QPP final rule (PDF), the Centers for Medicare & Medicaid Services (CMS) tripled the low-volume threshold for participation to the point where the agency estimates that only 37 percent of clinicians who bill Medicare will be required to participate in the QPP's Medicare Merit-based Incentive Payment System (MIPS).

The increase to the low-volume threshold means that physicians would be required to take part in MIPS if they treat 200 or more Medicare beneficiaries in a year or bill Medicare $90,000 or more in allowed charges. Because of this and other measures CMS is taking, the agency estimates that 90 percent of clinicians in practices of one to 15 and 97 percent of clinicians in all practice sizes will receive either a neutral or positive adjustment in 2020.

The initiation of virtual groups, the low-volume threshold, reduced requirements and bonus points for small practices are among the regulatory wins that would help small practices. Bonus points for treating complex patients and making 2018 another transition year were other regulatory wins, but CMS warned that requirements will get tougher in 2019 due to requirements in law.