On October 14, 2016, CMS issued its Final Rule for the new physician payment system under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA replaced the Medicare Sustainable Growth Rate (SGR) with a new physician payment method, the Quality Payment Program (QPP). Physicians may participate in the QPP through either the Merit-Based Incentive Payment System (MIPS) or an Advanced Alternative Payment Model (Advanced APM). The Final Rule makes several changes to the earlier Proposed Rule. The biggest change from the Proposed Rule is that, as previously announced in September, CMS will not require full MIPS participation in 2017. CMS also adjusted the low-volume threshold to exclude those clinicians with less than $30,000 in Medicare Part B revenue or fewer than 100 Medicare patients in a reporting year. MIPS MIPS is a new program for certain Medicare clinicians that will make performance-based adjustments to payment based on quality, cost, and other measures.