In the 2018 proposed Medicare Access and CHIP Reauthorization Act’s (MACRA’s) rule, published earlier this year, HHS has again proposed to exclude two-thirds of physicians, or 900,000, from participation in the Merit-based Incentive Payment System (MIPS). MIPS was created under 2015 MACRA legislation to incent financially Medicare physicians and other Medicare Part B clinicians to improve care quality and reduce Medicare spending growth. HHS is choosing to exclude smaller-sized physician practices because, it is believed, MIPS reporting requirements place too high a burden on less resourced practices. However, MACRA legislation includes a “virtual group” provision that allows for solo and small group practices to partner in meeting MIPS reporting requirements. For technical reasons the Centers for Medicare and Medicaid Services (CMS) was delayed in implementing the provision. The first year in which providers can participate in MIPS as a virtual group will be 2018. Designed correctly, virtual groups offer substantial advantages that include greater MIPS participation, more competitiveness, higher financial reward and more opportunity for small practices to keep their independence.