MIPS 2020 Final Rule

MIPS 2020: Key Takeaways

Last week, CMS released the final rule for the changes to the Merit-Based Incentive Payment System (MIPS) in 2020. Changes to the program next year are minimal, but are still important to note as you head into performance year 4.

Performance Category Weights

There will be no change to the performance category weights in MIPS performance year 2020.

MIPS Performance Categories

Payment Adjustment

For the 2020 performance period, the performance threshold (maximum number of points needed to avoid a negative payment adjustment) will increase from 30 to 45 points. The additional performance threshold for exceptional performance will increase from 75 points to 85.

The maximum positive payment adjustment for performance year 2020 will be increased to 9%, plus additional adjustments for exceptional performance. The maximum negative payment adjustment will be -9%.

Quality Performance Category

Data completeness for performance year 2020 will increase from 60% to 70%. This means you must report on at least 70% of your total patients who meet the measure’s denominator criteria in order to receive maximum points for the measure.

Improvement Activities Category

The Improvement Activities inventory has been updated for MIPS performance year 2020.

MIPS Year 4 Changes to Improvement Activities
  • IA_BE_25: Drug Cost Transparency
  • IA_CC_18: Tracking of clinician’s relationship to and responsibility for a patient by reporting MACRA patient relationship codes
  • IA_PSPA_28: Completion of an Accredited Safety or Quality Improvement Program
  • IA_PM_2: Anticoagulant Management Improvements
  • IA_EPA_4: Additional improvements in access as a result of QIN/QIO TA
  • IA_PSPA_19: Implementation of formal quality improvement methods, practice changes, or other practice improvement processes
  • IA_BE_7: Participation in a QCDR, that promotes use of patient engagement tools
  • IA_PSPA_7: Use of QCDR data for ongoing practice assessment and improvements
  • IA_BMH_10: Completion of Collaborative Care Management Training Program
  • IA_PM_1: Participation in Systematic Anticoagulation Program
  • IA_CC_3: Implementation of additional activity as a result of TA for improving care coordination
  • IA_PSPA_14: Participation in Quality Improvement Initiatives
  • IA_PSPA_5: Annual Registration in the Prescription Drug Monitoring Program
  • IA_PSPA_24: Initiate CDC Training on Antibiotic Stewardship
  • IA_BMH_3: Unhealthy alcohol use
  • IA_BE_11: Participation in a QCDR, that promotes use of processes and tools that engage patients for adherence to treatment plan
  • IA_BE_2: Use of QCDR to support clinical decision making
  • IA_BE_9: Use of QCDR patient experience data to inform and advance improvements in beneficiary
  • IA_BE_10: Participation in a QCDR, that promotes implementation of patient self-action plans
  • IA_CC_6: Use of QCDR to promote standard practices, tools and processes in practice for improvement in care coordination
  • IA_AHE_4: Leveraging a QCDR for use of standard questionnaires
  • IA_AHE_2: Leveraging a QCDR to standardize processes for screening
  • IA_PM_10: Use of QCDR data for quality improvement such as comparative analysis reports across patient populations
  • IA_CC_4: TCPI Participation

Previously, a group or virtual group could attest to an improvement activity if at least one clinician in the group participated in the activity. In 2020, in order for a group or virtual group to attest to an improvement activity, at least 50% of the clinicians in the group or virtual group must perform the same activity during any continuous 90-day period in the performance year.

CMS has also made a technical correction to the definition of ‘Rural Area’ that will not change how rural clinicians are identified.

Also modified are the requirements for patient-centered medical home (PCMH) designation. CMS has removed specific examples of entity names of accreditation organizations in order to remove barriers to designation.

Promoting Interoperability

Currently, hospital-based clinicians who choose to report as a group or virtual group are eligible for reweighting when 100% of the MIPS-eligible clinicians in the group meet the definition of a hospital-based MIPS eligible clinician. In the next performance year, these clinicians are eligible for reweighting when more than 75% of the NPIs in the group or virtual group meet the definition of a hospital-based MIPS eligible clinician.

MIPS Performance Year 2021

Although there are no major changes to the program for 2020, bigger changes are expected in performance year 2021. Subscribe to our MIPS newsletter to stay up to date on these future changes.

November 5th, 2019 Categories: featured, MIPS Information

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