Whitfield L. Knapple, MD, FACG
Chair, Legislative and Public Policy Council

On Thursday, May 31, CMS Administrator Seema Verma wrote on the CMS blog that she was “pleased to announce that 91 percent of all clinicians eligible for the Merit-based Incentive Payment System (MIPS) participated in the first year of the Quality Payment Program (QPP) – exceeding our goal of 90 percent participation.”  CMS also touted its success in:

  • Reducing the number of clinicians that are required to participate giving them more time with their patients, not computers.
  • Adding new bonus points for clinicians who are in small practices, treat complex patients, or use 2015 Edition Certified Electronic Health Record Technology (CEHRT) exclusively as a means of promoting the interoperability of health information.
  • Increasing the opportunity for clinicians to earn a positive payment adjustment.
  • Continuing to offer free technical assistance to clinicians in the program.

CMS also noted that under the Bipartisan Budget Act of 2018, the agency now has additional authority to continue out gradual implementation of certain requirements for three more years, in order to further reduce burden in areas of MIPS.

High on Praise, but Short on Details

ACG appreciates CMS’ initiatives in lowering MACRA reporting burdens, as well as excluding many small and rural practices from having to participate in MIPS.  ACG is also encouraged that CMS is discussing utilizing its new authority to continue gradual implementation and further reduce reporting burdens for another 3 years.  The College hopes that this is a positive sign when CMS releases the proposed policy changes for the CY 2019 Medicare fee schedule and QPP in July.  As ACG President Dr. Irving Pike discussed in February, the College appreciates all the ACG members and ACG Governors who successfully advocated for these important changes in 2017 and in early 2018.

However, CMS’ latest announcement does not provide important details on Year 1 of MACRA.  While CMS touted the 90%+ participation rate, CMS did not release other important details, such as:

  • Where did providers fall on the scoring spectrum? What percentage of providers are slated for bonuses or cuts?
  • What was the percentage of providers who reported just enough information to avoid a reimbursement cut in CY 2019?
  • What was the percentage of providers who qualified for the “exceptional bonus” category?
  • What was the success rate of solo and small practices? For medium to larger practices?
  • How many providers were able to qualify for hardship exemptions?
  • What is the percentage of providers who not only reported quality measures, but submitted complete data?

These are the questions that ACG believes will help gauge whether MACRA Year 1 was a success or not.  ACG has been informed that more data are forthcoming.  Thus, ACG will update membership as soon as these data are publicly available.  ACG will also continue to advocate on your behalf as CMS proposes the changes for Year 3.


CMS….QPP… MACRA… MIPS… APMs… QCDRs… ACOs… Why does Washington D.C. love acronyms and complicated payment systems?  What the heck is going on here?  ACG Hopes to Keep This Simple.   We compiled a detailed overview for you that seeks to make some sense out of this alphabet soup – but hopefully in a simplified fashion and in plain English.  Read the summary and potential impact to GI.

Dissecting MACRA:
Year 1
(reporting year 2017; payment year 2019)
Year 2 (reporting year 2018; payment year 2020)

Whitfield L. Knapple, MD, FACG

Chair, ACG Legislative and Public Policy Council