Yesterday, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule updating the requirements of the quality payment program (QPP) for physicians and eligible clinicians mandated by the Medicare Access and CHIP Reauthorization Act of 2015. The QPP includes two tracks – the default Merit-based Incentive Payment System and advanced alternative payment models. The rule proposes key policies for the QPP's 2018 performance period, which will affect clinician payment in 2020. Among other policies, CMS proposes to increase the MIPS's low-volume threshold, thereby excluding more than 585,000 eligible clinicians from the program. CMS also proposes to implement a MIPS reporting option that allows hospital-based clinicians to use their hospital's value-based purchasing measure results in the MIPS program. CMS also proposes to continue using a 90-day reporting period for the advancing care information category in 2018, and to allow clinicians to use the 2014 edition of certified electronic health records for the ACI category. In addition, CMS proposes policies related to clinicians' ability to earn incentives for participation in advanced APMs. This includes more detail regarding the all-payer option that, beginning in 2019, will allow clinicians to qualify for advanced APM incentives based on combined participation in alternative payment arrangements with Medicare and non-Medicare payers (including Medicare Advantage, Medicaid and private payers).​