In 2018, most pathologists will need to take action to stop penalties from reducing future Medicare payments for their services mandated by MACRA. As is the case this year, nearly all pathologists will be required to participate in Medicare's Merit-based Incentive Payment System (MIPS). A physician's performance in MIPS in 2017 and 2018 affects his or her Medicare payment in 2019 and 2020, respectively. The CAP is working to ensure pathologists can comply with MIPS, which is the default pathway under the QPP. The CAP will launch the Pathologists Quality Registry in October 2017, which can be a reporting option for the 2018 MIPS performance period. The MIPS program is estimated to have a $1.5 billion overall impact on the pathology specialty beginning in 2019. In recent months, the CAP recommended several changes to the CMS regarding MIPS, to mitigate cuts and ensure pathologists can fairly participate in the program. These recommendations include: Hold pathologists harmless by using a median score for MIPS categories that non-patient facing eligible clinicians cannot report or participate in; Use Medicare enrollment records to define non-patient facing eligible clinicians; Extend the life of quality measures used by pathologists and Outline the Clinical Practice Improvement Activities (CPIA) and their impact on pathologists.