Performance is measured through the data clinicians report in four areas - Quality, Improvement Activities, Promoting Interoperability (formerly Advancing Care Information), and Cost. MIPS was designed to update and consolidate previous programs, including: Medicare Electronic Health Records (EHR) Incentive Program for Eligible Clinicians, Physician Quality Reporting System (PQRS), and the Value-Based Payment Modifier (VBM).
2020 MIPS Changes:While all category weights remain the same, there are several substantial changes to MIPS in 2020 that organizations should be aware of.
Higher Performance Thresholds and Penalties:
CMS is increasing the performance threshold (the number of MIPS points required to be exempt from the penalty) from 30 points in 2019 to 45 in 2020. The exceptional performance threshold has also been increased from 75 points in 2019 to 85 in 2020 and 2021. Also, the payment adjustments in MIPS will increase from +/-7% in 2019 to +/-9% in 2020. What this means is the maximum penalty for not reporting in 2020 will rise to negative -9% while the incentive increases to +9%.
However, due to federal budget neutrality requirements, any positive payment adjustments are expected to be below 9%.
Under Quality, the data completeness requirement jumps to 70%. Thus, quality measures will be reportable for at least 70% of eligible cases for Medicare and non-Medicare patients. Measures submitted that don’t meet the data completeness threshold would garner 0 points. However, small practices will continue to receive 3 points on measures that don’t meet requirements. Other category changes include removing or topping out several Quality measures, new specialty sets for speciﬁc clinicians
Promoting Interoperability (PI) Changes:
While no significant changes will be made to PI in 2020, there are some minor adjustments.Beginning with the 2020 performance period, CMS removes the Verify Opioid Treatment Agreement measure and keeps the Query of PDMP measure as optional.
Improvement Activities (IA) Changes:
For group reporting, the participation threshold is increased from a single clinician to 50% of the clinicians in the practice. At least 50% of a group’s NPIs must perform the same activity for the same continuous 90 days in the performance period.
CMS is adding ten new episode-based measures and revising both the current Medicare Spending Per Beneficiary Clinician measure and Total Per Capita Cost measure. However, no changes will be made to current case minimum requirements