Physician Payment Reform

The passage of Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) repealed the Sustainable Growth Rate (SGR) and replaced it with two new payment update tracts, the Merit-based Incentive Payment System (MIPS) and CMS Alternative Payment Models (APMs). The MIPS and APM programs are scheduled to go into effect January 1, 2019.

MACRA created the MIPS to replace
the current CMS Quality Initiative
Programs. MIPS incorporates aspects
of several CMS quality programs into
a component score to determine physician payment.

Learn More about MIPS

APMs are a class of payment reform 
that incorporates quality and total
cost of care into reimbursement
rather than a traditional fee-for-service

Learn More about APMs

Summary of Proposed 2018 MIPS and APM Reporting Requirements 
On June 20, CMS released the 2018 proposed rule for the MIPS and APM programs. The proposed rule includes details on MIPS performance category reporting for 2018, details on upcoming Virtual Group participation, available exclusions including the low-volume threshold for 2018, and APM requirements and definition. The proposed rule and a CMS proposed rule fact sheet can be found on CMS' resource library. For questions regarding 2018 proposed requirements, contact the Health Policy team at

The Academy has published a summary of the 2018 MIPS and APM reporting requirements for Otolaryngologists, including details on proposed provisions directly affecting your practices. Access the Academy summary document here

CMS Releases New Quality Payment Program (QPP) Resources
CMS has added additional resources to the QPP website to help clinicians participate in the MIPS and APM programs. Resources include a MIPS Quick Start Guide and updated fact sheets. Clinicians can also access a web tool on the QPP webpage to check their MIPS participation status. Clinicians can access these resources on the QPP webpage here. 

Academy Comments on Post-SGR Payment Policy with CMS MIPS and APM Final Rule
On December 19, the Academy commented on the final rule released by CMS that solidifies the details of the two new payment update tracks, the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). These programs were created by the historic legislation that repealed the SGR, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). In the final rule, CMS adjusted several key aspects of the program that Academy submitted comments last spring. Important changes to the program include:

  • Clinicians have the option to pick their pace with three reporting periods for MIPS:
    • Test Pace: Report some data in 2017.
      • 1 quality measure, or 1 improvement activity, or 4/ 5 required advancing care information (ACI) measures.
    • Partial MIPS Reporting: Report one or more MIPS categories for at least 90 consecutive days in 2017 (must begin reporting by October 2, 2017).
      • 1+ quality measure, or 1+ improvement activities, or 4/ 5 required ACI measures
    • Full MIPS Reporting: Report all MIPS categories for at least 90 consecutive days in 2017 (must begin reporting by October 2, 2017).
  • The low volume threshold excluding clinicians from MIPS reporting was increased to “Medicare billing charges of more than $30,000, and provide care to more than 100 Medicare patients per year.”
  • For CY 2017 only, CMS eliminated Cost as a MIPS reporting category. In CY 2018, MIPS participants will receive cost scores based on adjudicated claims data.

The Academy commented on the reduced reporting requirements for the transition year; MIPS performance category criteria and scoring; Qualified Clinical Data Registry (QCDR) and quality measure reporting requirements; and applicability of APMs to Otolaryngologists - Head and Neck Surgeons. The Academy's comments are available here.