As we reported last month, CMS’ proposed rule updating MACRA’s Quality Payment Program (“QPP”) for CY 2018 would extend and expand exceptions that would allow many practitioners to avoid participating in its Merit-based Incentive Payment System (“MIPS”) during next year’s performance period. In particular, the proposed rule would increase the low-volume threshold for MIPS-participation from $30,000 to $90,000 and present additional opportunities for advanced alternative payment model participation. In 2017, approximately 800,000 practitioners were exempted from MIPS-participation and CMS estimates that an additional 134,000 would be exempted under the proposed rule, leaving less than 40% of eligible practitioners subject to MIPS participation in 2018.

While another year of MIPS-exemption may be welcome news to many practitioners, exempt practitioners should not use this reprieve to procrastinate on MIPS preparation. Whatever short-term flexibilities CMS is willing to offer, it is marching ahead with MIPS-implementation and current exemptions may not be available beyond 2018. Given the potentially substantial impact that MIPS performance may have on reimbursement in the future, practitioners wishing to position themselves for success should focus now on evaluating and improving their performance in each of the MIPS measurement areas. If you are such a practitioner, taking the steps and considering the questions set forth below would be a good place to start:

• Review CMS’ list of proposed quality improvement activities. Is your practice engaged in any of these activities? Are there any that would benefit your practice and patients? If so, begin thinking about implementation strategies.

• Are you using 2015 Certified Electronic Health Record Technology (“CEHRT”) in your practice? While CMS’ proposed rule would allow practitioners to use 2014 CEHRT without penalty for the 2018 performance year, practitioners using 2015 CEHRT would earn bonus points; 2015 CEHRT may also be required in future performance years. If you are not currently using 2015 CEHRT, you should consider the possibility of adopting a 2015-certified product, particularly as more such products become available.

• Physician practitioners who are not yet MIPS-participants may wish to review their Physician Quality Reporting Program performance for prior years to begin to identify strengths and weaknesses that could carry over into MIPS quality evaluation, as well as to begin to identify strategies to maximize performance if needed.

• While the MIPS cost performance category will continue to be accorded no weight for the 2018 performance year, its weight will jump to 30% beginning in performance year 2019. If you are non-exempt from MIPS measurement for the first time in 2019, you may also be among the first group of providers to be scored based on cost. While practitioners will not be required to submit cost information to CMS, gearing up to optimize performance in this category, in addition to the three other MIPS performance categories, may be overwhelming in the absence of adequate preparation. Practitioners, therefore, should consider beginning to plan now, including by reviewing their past Value-Based Payment Modifier performance to identify their strength in cost control performance, as well as potential for improvement.

• For the first time in 2018, CMS will allow solo practitioners and practitioners in small physician groups to form, report via, and be scored as “virtual groups.” To be scored as a virtual group for performance year 2018, practitioners must submit written agreements by December 1, 2017; a 2018 deadline is likely for practitioners interested in participating in virtual groups for performance year 2019. Eligible, interested practitioners should begin to plan for this possibility.

Consider whether you qualify for participating in an advanced alternative payment model and whether such participation would be beneficial to your practice. CMS is adding a Medicare Track 1+ option to its Medicare Shared Savings Program, as well as reopening applications for its Next Generation ACO option and its Comprehensive Care Plus program. Each of these programs will require submission of applications in 2018 to participate for the 2019 performance year. As practitioners launch from these initial considerations into an in-depth analysis of their current MIPS potential and strategies for maximizing scoring, Sheppard Mullin is available to provide individually-tailored guidance and focus based on its experience and expertise in helping clients prepare to thrive under MACRA.