Physician payment update

MACRA—After final rule, here’s what you need to know for 2017

Learn the essential details physicians should understand about participating in MACRA’s Quality Payment Program next year.


Now that the Centers for Medicare and Medicaid Services have released a final MACRA rule, solidifying the agency’s plans for its new physician payment program, dubbed the Quality Payment Program (QPP), here are the essential details physicians need to know for next year.

MACRA/Quality Payment Program: What you need to know

  • Physicians who elect not to participate in the new payment program at all in 2017 will be subject to a 4% payment penalty in 2019 on their Medicare Part B earnings.
  • Because CMS is offering physicians significant flexibility on reporting for MACRA/QPP in 2017, as long as you participate at some level, you can avoid the penalty. Your participation can be as minimal as reporting on a single quality measure in the new program for a 90-day period. However, it’s a good idea to aim for doing more than that to test out the new system and ease your transition into it. If you report on more measures, you may even qualify for bonus payments.
  • The AOA will continue to develop educational materials for DOs to walk them through the transition to the new payment system. You can find the latest news and updates at

The nitty-gritty

Below are a few more details on various aspects of the final rule, along with the AOA’s stance and analysis.

  • Overall, the rule demonstrates CMS heard many physician concerns with MACRA and has started to address them. The conversation is moving in the right direction.
  • The modifications to the merit-based incentive payment system (MIPS) program from the proposed rule at least for the transition period are good news. In particular, reductions to the number of measures being reported in 2017 and a de facto removal of the cost category for this first year will help ease the transition. CMS has also stated they will also have some accommodations in 2018 to provide additional time to transition.
  • CMS has partially addressed MIPS’ problematic EHR measurement approach by significantly cutting the number of measures that must be reported and shortening the reporting period. It has also stated it will explore how to move away from a measure-based approach to assessing EHR use in subsequent years.
  • More small practices will be exempt from MIPS because CMS significantly raised the low-volume threshold in the final rule—if you bill under $30,000 in Medicare, or have 100 patients or less, you’ll likely be exempt.
  • CMS reduced the number of clinical practice improvement activities required by all, and then further halved even that amount for small practices, or those in rural, or underserved areas—where many DOs practice.

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