MIPS Category Weights

2019 VS. 2020

MIPS2019MIPS2020

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%.

Quality Changes:

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.

Cost Changes:

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


Quality Measures

Category is Worth 45% of total MIPS score (same as 2019).

Data Completeness:

  • Submitted Quality measures must contain at least 70% (instead of 60% in 2019) of all Eligible Clinician patients across all payers.

  • Participants must submit data for at least 6 measures for the 12-month performance period (January 1 - December 31, 2020).

Participants should:

  • Submit collected data for at least 6 measures, or a complete specialty measure set; and

  • One of these measures should be an outcome measure; if you have no applicable outcome measure, you can submit a high priority measure instead

Scoring:

  • Maintains 3-point floor for measures scored against a benchmark. Maintains 3 points for measures that don’t have a benchmark or don’t meet case minimum requirement.

  • Measures that do not meet data completeness requirements will get 0 points instead of 1 point, except that small practices (15 or less in the TIN) will continue to get 3 points.

  • Small practices would still receive a 6 point bonus added to the Quality performance score.

High Priority Bonus Points Remain the Same (after first required measure):

  • 2 points for outcome, patient experience;

  • 1 point for other high priority measures which need to meet data completeness, case minimum, and have performance greater than 0; Capped bonus points at 10% of the denominator of total Quality performance category;


Promoting Interoperability
(Formerly Advancing Care Information)

Category is Worth 25% of total MIPS score

CMS has renamed the Advancing Care Information performance category to Promoting Interoperability (PI) to focus on patient engagement and the electronic exchange of health information using certified electronic health record technology (CEHRT). This performance category replaced the Medicare EHR Incentive Program for EPs, commonly known as Meaningful Use. This is done by proactively sharing information with other clinicians or the patient in a comprehensive manner. This may include: sharing test results, visit summaries, and therapeutic plans with the patient and other facilities to coordinate care.

  • MIPS eligible clinicians must continue to use 2015 Edition certified EHR technology to report this category.

  • Must report on all measures.If you do not report on any of the required measures (or if you do not claim an exclusion) you will receive a total score of zero in this category.

  • Beginning with the 2020 performance period, CMS removes the Verify Opioid Treatment Agreement measure and keeps the Query of PDMP measure as optional.

    • Security is still a top priority:

    The Security Risk Analysis measure in the Protect Patient Health Information objective is still required but it is an unscored measure for every practice. EHR vendors are not responsible for making their products compliant with HIPAA Privacy and Security Rules. It is solely practice responsibility to have a complete risk analysis conducted.

  • Visit the list of Promoting Interoperability measures: Explore Promoting Interoperability Measures

    Fact Sheet

    Security Risk Analysis Tip Sheet


Improvement Activities

Category is Worth 15% of total MIPS score

This is a new performance category that includes an inventory of activities that assess how you improve your care processes, enhance patient engagement in care, and increase access to care. The inventory allows you choose the activities appropriate to your practice from categories such as, enhancing care coordination, patient and clinician shared decision-making, and expansion of practice access.  

To earn full credit in this category, participants must submit one of the following combinations of activities (each activity must be performed for 90 days or more during 2020):


COST

Category is Worth 15% of total MIPS score (same as 2019)

This performance category replaces the VBM. The cost of the care you provide will be calculated by CMS based on your Medicare claims. MIPS uses cost measures to gauge the total cost of care during the year or during a hospital stay. CMS will calculate cost measure performance; no action is required from clinicians.