HealthEC Blog Posts

MIPS Changes for 2018

Happy New Year!

Now it’s time to focus on all those resolutions.

And along the lines of making personal changes in the new year, it’s also time for professional ones – more specifically, focusing on MIPS reporting changes for 2018 as part of CMS’s efforts to reduce complications and unnecessary utilization of resources through more efficient, holistic patient care management.

But before getting started, it’s important to note that providers still have until March 31, 2018 to submit data for Performance Year 2017. It’s not too late to submit data and avoid penalties! For some last-minute advice on 2017 MIPS reporting, listen to HealthEC’s Sanjay Seth, MD, speak with HealthcareNOW Radio.

Back to 2018. A key difference will be the cost measure coming into play, and in turn, shifting category weightings. Cost will now comprise 10 percent of reporting with quality lowered to 50 percent (from 60 percent). Advancing care information (ACI) and improvement activities (IA) remain at 25 percent and 15 percent, respectively.

The 2018 cost measure will be calculated using the Medicare Spending per Beneficiary (MSPB) and total per capita cost measures. These two measures will be carried over from the Value Modifier program and are currently being used to provide feedback for the MIPS transition year. CMS will calculate cost measure performance; no action is required from clinicians. One might believe there isn’t much that can be done to impact CMS’s calculation, but there is. Providers can examine ways to avoid unnecessary utilization of resources, which is also reviewed in Dr. Seth’s HealthcareNOW interview podcast.

Further, 365 days’ worth of data must now be submitted for quality measures. Data reporting for ACI can be from 90 days to 365 days, and IA holds steady at 90 days.

Other items of note for 2018 include:

  • Medicare reimbursement adjustments expand a percentage point, with a maximum incentive or penalty of 5 percent.
  • The performance threshold (the bare minimum score to avoid penalty) rises from three points to 15. Despite the fivefold increase, reaching the new threshold can be done with relative ease by focusing more on quality or IA categories.
  • More providers are exempt from submitting data because of the new low volume threshold – a boost for clinicians in smaller practices with lower Medicare volume. Providers with ≤$90,000 in Part B allowed charges or ≤200 Part B beneficiaries will not be subject to MIPS, compared with a MIPS threshold of ≤$30,000 in charges or ≤100 beneficiaries in 2017.
  • Designed to reduce the strain on qualified small practices, groups with 15 or fewer clinicians that submit data on at least one performance category are automatically awarded five bonus points.
  • In the wake of last year’s devastating hurricane season, CMS has added an extreme and uncontrollable circumstances exemption for practices unable to meet reporting requirements because of natural disasters or other emergencies.

As a final note, the main focus of CMS over the next few years is to push all clinicians into an ACO or Advanced APM. Therefore, CMS is reducing the burden on those clinicians who are already part of these groups, as they are sharing more risk amongst themselves.

So, as we start 2018, good luck with all those New Year’s resolutions, and of course, your 2018 MIPS reporting.

Should you require additional information about MIPS reporting, we are always available to help! Feel free to contact us at (732) 902-0070 or

Jessica Kullman

Blogger Name: Jessica Kullman

Date of Publishing : January 23, 2018

About the Author : Jessica Kullman is the QCDR MIPS Program Manager for HealthEC