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    How will urologists fare under 2018 MIPS rule?

    Nearly three-fourths of urologists may receive exceptional payment adjustment in 2020

    Robert A. Dowling, MDRobert A. Dowling, MDThe 2018 updates to the Quality Payment Program established by MACRA were published on June 30, 2017. In general, the Centers for Medicare & Medicaid Services (CMS) has lowered thresholds for participation and positive adjustments under the Merit-based Incentive Payment System (MIPS) in 2018 compared to the original plan, and in some cases delayed or eased other aspects of implementation.

    MACRA is legislation that was passed with bipartisan support in 2015, and the proposed rule carries no suggestion that the foundation of payment adjustments or bonuses based on quality is going to change. Here are some highlights of the proposed rule that are likely to get finalized in the fall—and the possible impact on urology providers. (For more on this rule, see “Proposed MIPS rule modifies 2018 requirements.")

    Payment, patient thresholds set for change

    Providers who see few patients or payments from traditional Medicare fee for service may be exempt from MIPS. CMS has proposed to raise that threshold for exemption from $30,000 to $90,000 per year in 2018 and raise the patient threshold from 100 to 200 payments—thus excluding more providers from MIPS.

    Also by Dr. Dowling - CMS financial data: Who is getting paid what?

    Urologists should be aware that should they elect to report individually, rather than as a group, many non-physician providers (nurse practitioners, physician assistants) could fall below these thresholds and be exempt. On the other hand, the threshold is the same for individuals and groups, so group reporting would likely subject these low-volume providers to inclusion in MIPS. Low-volume providers may opt in to the MIPS program and may consider doing so if they feel confident in their ability to receive a positive adjustment.

    CMS has proposed maintaining the same weights for the four categories that comprise the MIPS composite score in 2018: Quality, 60%; Cost, 0%; Advancing Care Information, 25%; and Improvement Activities, 15%. The Quality category will continue to contribute the majority of weight to MIPS in 2018, is arguably complex, and now will be reported for 12 months. The Cost category is perhaps the least understood and by statute must comprise 30% of the weight in 2019. Urologists should become familiar with their Quality Resource and Utilization Report available from CMS. This report is the closest approximation of a predictor for performance in the Cost category under MACRA and contains rich patient, physician, and hospital-level detail about patients attributed to each provider in the practice (by tax ID number).

    Next: Urologists projected to fare well

    Robert A. Dowling, MD
    Dr. Dowling is president of Dowling Medical Director Services, a private health care consulting firm specializing in quality ...

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