Making Sense of MACRA: Navigate Changes to the Quality Payment Program in 2018


Here's how to succeed in the four performance categories of the Merit-based Incentive Payment System: quality, cost, improvement activities, and advancing care information.

Fam Pract Manag. 2018 Mar-Apr;25(2):37-40.

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Navigating the Quality Payment Program (QPP) will set you up on a path for success in the four performance categories of the Merit-based Incentive Payment System (MIPS): quality, cost, improvement activities (IA), and advancing care information (ACI).


MIPS-eligible clinicians are required to report six quality measures, including one outcome measure. The 2017 transition year allowed ECs to report on as few as one patient a single time to avoid a negative payment adjustment.

The reporting criteria has increased for the 2018 performance period. Beginning in 2018, ECs are expected to report a full calendar year (January 1-December 31, 2018) of quality data. In addition, the data completeness criteria has increased. ECs reporting using a qualified registry, qualified clinical data registry (QCDR), or an electronic health record (EHR) will need to report on at least 60% of patients eligible for the measures selected, regardless of payer. ECs reporting using claims will need to report on at least 60% of Medicare Part B patients eligible for the measures selected.


One of the major changes made in the 2018 QPP final rule is the inclusion of cost in the MIPS final score. In the 2017 transition year, cost was not included in the MIPS final score.

For the 2018 performance period, cost will carry a weight of 10% and increase to a weight of 30% beginning in 2019. As the weight of the cost category increases, the weight of the quality category decreases.

For the 2018 performance period, the cost category will be measured for a full calendar year and assessed using two measures: Total per Capita Cost and Medicare Spending per Beneficiary (MSPB). While these measures were included in the previous Value-based Payment Modifier (VM) program, they are still unfamiliar to many physicians. CMS is developing episode-based measures to be used in future program years. The first round of episode-based measures will be introduced in the 2019 performance period.

The cost performance category does not require any data submission. CMS will automatically calculate these measures using claims data.

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