MACRA: Navigating The Final Rule Part 2

Vice President
Government Affairs &
Client Solutions

Welcome Back! 

Welcome back to the second blog in our series, MACRA: Navigating The Final Rule, dedicated exclusively to helping you navigate the murky waters of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). In case you missed it, be sure to check out the first blog in our series to learn more about key changes your practice will see during the 2017 transition year of the new Quality Payment Program (QPP).

This blog will outline changes from the QPP proposed rule regarding the MIPS Composite Performance Scoring Categories for 2017 and beyond.

Proposed Rule Final Rule
Quality 50% Quality 60% (2017)
Advancing Care Information 25% Advancing Care Information 25%
Clinical Practice Improvement Activities 15% Improvement Actives 15%
Cost 10% Cost 0% (2017)

Specific Changes for MIPS Composite Scoring Breakdown


Weight: Because the 2017 performance year will be a transition year for MACRA, CMS announced that the Quality category will be weighted at 60% (ONLY for the 2017 performance period). The weight placed on the Quality category will decrease to 50% in 2018 and 30% in 2019 and beyond.
In the proposed rule, the Quality category was weighted at 50%.

Proposed Rule 2017 2018 2019 & Beyond
50% 60% 50% 30%


Cross-Cutting: CMS has eliminated the cross-cutting requirement and stated that eligible clinicians (EC) only have to report on ONE outcome measure.
The proposed rule stated that EC were required to report on one cross-cutting measure AND one outcome.

Data Completeness: As part of the changes made in the final rule, EC will now be able to submit 50% of patient data across all payers and not only Medicare Part B patients.
Currently in the PQRS program, EC are required to submit 50% of all Medicare Part B payer data.  

Advancing Care Information:

Optional Objectives: “Coordination of Patient Care through Patient Engagement” and “Public Health and Clinical Data Registry Reporting” objectives are now optional. Though a public health registry is not required as part of the ACI category, EC that have a registry are able to receive a 5% bonus. Due to this change, EC will now only need to complete 6 objectives in order to receive full credit for the ACI category.
The proposed rule required that 10 objectives be completed in order for EC to receive full credit.

Improvement Activities:

What Is it?
Just a name change! When CMS released the final QPP rule, there was one major difference that your practice may have noticed. The reporting category formerly known as “Clinical Practice Improvement Activities” has been changed to “Improvement Activities.” CMS also defined an Improvement Activity as “an activity that relevant EC organizations and other relevant stakeholders identify as improving clinical practice or care delivery.”

Special Considerations: In addition to small practice special considerations discussed in our previous blog, CMS announced that small practices with 15 or fewer EC, located in rural areas, and health professional shortage areas (HSPAs), will only be required to submit half the amount of required activities in order to receive full credit.

  • Practices given special consideration will be required to complete 1 high-weighted or 2 medium-weighted Improvement Activities to receive full credit. Practices without special consideration will be required to complete 2 high-weighted or 4 medium-weighted, or any combination of both Improvement Activities to receive full credit.

Click here to learn more about the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)

Improvement Activities Subcategories: CMS also included the eight subcategories that practices can be evaluated on in this category. EC must select a combination of Improvement Activities from 90+ options for the chance to earn a total of 40 points.
EC were required to earn 60 total points in the proposed rule.

List of 8 Subcategories:

  1. Expanded Practice Access
  2. Population Management
  3. Care Coordination
  4. Beneficiary Engagement
  5. Patient Safety & Practice Assessment
  6. Achieving Health Equity
  7. Emergency Response  & Preparedness
  8. Integrated Behavioral & Mental Health


New Weight: Due to the 2017 transition year, the Cost category will be weighted at 0% (ONLY for the 2017 performance period). However, the weight for this category will increase to 10% in 2018 and to 30% in 2019 performance year and beyond.
This is a change from the proposed rule which stated the Cost category would be weighted at 10%.

Proposed Rule 2017 2018 2019 & Beyond
10% 0% 10% 30%


Quality and Resource Use Reports (QRUR): Since implementing a Cost category as part of QPP, eligible clinicians will now be scored on the cost effectiveness of their care beginning in 2018. While this category will not be included in your MACRA score for 2017, you will receive feedback on this reporting category.

TSI Healthcare Bonus: As part of our new service line, Quality Program Services, TSI Healthcare will offer QRUR reports and analyses that can identify top spending categories and help you determine areas that need improvement to increase the cost effectiveness of your care. View a sample QRUR report below. 

Need more help navigating MACRA? Watch our webinar “MACRA: The Final Rule,”
to learn more about the changes that will take effect in 2017.

Watch The Recording

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