The Centers for Medicare & Medicaid Services (CMS) is inviting comments on a proposed rule that would make 2018 a second transition year for the Quality Payment Program under MACRA. If finalized, it means that physicians who report only one quality measure in 2018 can avoid Medicare Part B payment penalties in 2020. For small practices, the proposed rule would allow the creation of virtual groups, provide automatic bonus points, and add a hardship exemption from the EHR category. Other highlights of the proposed rule are: it expands the low-volume threshold to $90,000 or less in Medicare Part B allowed charges or 200 or fewer Medicare Part B patients; physicians will not be scored on “resource use” (physician cost) in 2017; and it provides bonus points for treating complex patients. The California Medical Association (CMA) will submit comments on the proposed rule in their continuing fight to reduce the regulatory burden MACRA places on physicians. To read the proposed rule and find out how to comment on it, go to You may post comments online at