MIPS 2021: Final Rule Key Takeaways

The Centers for Medicare and Medicaid Services (CMS) has released the Quality Payment Program (QPP) final rule for the 2021 performance year. Due to the challenges clinicians are facing during the COVID-19 public health emergency, CMS avoided major changes to the program in order to minimize the burden. Here are the key changes to the Merit-Based Incentive Payment System program for 2021.

MIPS Value Pathways (MVPs)

CMS has finalized updates to the guiding principles to help define what MVPs will look like in the future. Implementation of MVPs will not occur in 2021 as previously anticipated, but will be available in 2022.

APM Performance Pathway

CMS has finalized the APM Performance Pathway (APP), a new reporting framework complementary to MVPs, to begin in 2021. This framework is available only to APM participants and is composed of a fixed set of measures for each performance category.
  • The Cost category will be weighted at 0%
  • The Improvement Activities score will be automatically assigned based on the requirements of the MIPS APM in which the MIPS eligible clinician participates
  • Promoting Interoperability will be reported and scored at the individual or group level
  • The Quality measure set will consist of:
    • The CAHPS for MIPS survey measure
    • 2 measures that will be calculated by CMS using administrative claims data
    • 3 quality measures that can be reported as electronic clinical quality measures (eCQMs), MIPS CQMs, or Medicare Part B claims measures

Performance Category Weights

In 2021, the Quality performance category weight will be reduced from 45 percent to 40 percent. The Cost category weight will increase from 15 percent to 20 percent.

Performance Threshold

For the 2021 performance period, the performance threshold (maximum number of points needed to avoid a negative payment adjustment) from 45 to 60 points.

Performance Categories

Quality Category
CMS announced in the proposed rule earlier this year its intent to end the CMS Web Interface as a quality reporting option for ACOs and registered groups, virtual groups, or other APM Entities beginning with the 2021 performance period. Due to timing concerns because of the Public Health Emergency, CMS has decided to extend the availability of this submission type through 2021, and will sunset the CMS Web Interface in 2022. CMS had also proposed to use performance period benchmarks, rather than historical, to score quality measures in the 2021 performance year. However, it was decided in the final rule to continue with the use of historical benchmarks.
Improvement Activities Category
Minimal updates will be made to the Improvement Activities inventory. CMS will also create policies to include an exception to the Annual Call for Activities nomination period timeframe during a public health emergency, as well as an additional new criterion for nominating new improvement activities. In 2021, there are no changes to the requirement that 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.
Cost Category
CMS will update existing measure specifications to include telehealth services that are directly applicable to existing episode-based cost measures and the TPCC measure.

COVID-19 Flexibility Scoring

For the 2020 performance period only, the maximum number of bonus points available for the complex patient bonus would be 10, to account for the additional complexity of treating patients during the COVID-19 public health emergency.

Third-Party Intermediaries

Third-party intermediaries such as Qualified Clinical Data Registries (QCDRs), Qualified Registries (QRs), and health IT vendors will be allowed to support the APM Performance Pathway starting in 2021, and the MVP framework starting in 2022. CMS will establish specific data validation requirements for QCDRs and QRs. In performance year 2021, all third-party intermediaries will be required to attend and complete training and support sessions as specified by CMS.

MIPS and SurveyVitals

SurveyVitals can help you satisfy certain MIPS requirements. Learn more on our MIPS page, sign up for a demo, or chat with us using the blue chat icon below.

December 4th, 2020 Categories: Patient Experience

Recent Posts

respond to online reviews
Best Practice: Responding to Online Reviews
March 3, 2021

Over 80% of patients turn to Google when looking for a new healthcare provider. SurveyVitals’ online reputation tools have helped boost client Google reviews by 281%. While increasing your number of online reviews is essential for attracting new patients, it’s equally important to respond to these reviews appropriately. Patients are certainly reading online reviews, but […]

Tips to Ease Telehealth Wait Time Concerns
February 17, 2021

Wait times have long been a common concern for patients at office-based medical appointments. When telehealth skyrocketed in popularity last year, it became clear that wait times are even more of a frustration for patients during virtual visits. The numbers show wait times are the biggest pain point for patients who use telehealth. While the […]

Four Ways Reception Affects the Patient Experience
February 12, 2021

When measuring the patient experience, it’s important not only to examine the doctor-patient relationship and interactions with clinical staff, but also where it all begins: at reception. Although front desk staff aren’t treating patients, their role in the patient experience is critical. It’s so important, in fact, that a patient may switch doctors simply because […]

Test Results via the Patient Portal: Best Practices
February 1, 2021

A common concern expressed by patients is the communication of test results. Many medical practices have turned to patient portals to alleviate these concerns. Patient portals are now responsible for communicating with many of the 1-2 million patients being tested for COVID-19 every day in the US. The patient portal can be a great tool […]