What are the ways MACRA has changed in 2019?

The Centers for Medicare & Medicaid Services (CMS) published its Quality Payment Program Year 3 Final Rule in November 2018. The document details a number of changes for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) for independent physicians in 2019. In its fact sheet, CMS highlights the following changes:

• Expanding the definition of MIPS eligible clinicians to include new clinician types (physical therapists, occupational therapists, speech-language pathologists, audiologists, clinical psychologists, and registered dietitians or nutrition professionals), adding a third element to the low-volume threshold determination, and giving eligible clinicians who meet one or two elements of the low-volume threshold the choice to participate in MIPS (referred to as the opt-in policy).
• Adding new episode-based measures to the Cost performance category, restructuring the Promoting Interoperability (formerly Advancing Care Information) performance category, and creating an option to use facility-based Quality and Cost performance measures for certain facility-based clinicians.
• Increasing the small practice bonus to 6 points but including it in the Quality performance category score of clinicians in small practices instead of as a standalone bonus.
• Continuing to award small practices 3 points for submitted quality measures that don’t meet the data completeness requirements.
• Allowing small practices to continue submitting quality data for covered professional services through the Medicare Part B claims submission type for the Quality performance category.
• Providing an application-based reweighting option for the Promoting Interoperability performance category for clinicians in small practices.
• Continuing to provide small practices with the option to participate in MIPS as a virtual group.
• Offering a no-cost, customized support to small and rural practices through the Small, Underserved, and Rural Support (SURS) technical assistance initiative.
• Overhauling the MIPS Promoting Interoperability (formerly Advancing Care Information) performance category to support greater electronic health record interoperability and patient access while aligning with the Medicare Promoting Interoperability Program requirements for hospitals.
• Moving clinicians to a single, smaller set of objectives and measures with scoring based on measure performance for the Promoting Interoperability performance category.
• Allowing the use of a combination of collection types for the Quality performance category.
• Retaining and increasing some bonus points: MIPS performance threshold will be raised from 15 points to 30 points; the exceptional performance threshold will be raised from 70 points to 75 points
• For the Cost or Quality performance categories, providing the option to use facility-based scoring for facility-based clinicians, who are planning to participate in MIPS as a group. This option does not require data submission. A facility-based scoring preview is expected to be released in Q1 of 2019.