On November 2, 2017, the Centers for Medicare & Medicaid Services (CMS) released updates to the QPP for the 2018 performance period. Follow The Quality Payment Program Year 2. Overview to see major program changes.

In this article we will try to get more details of changes in MIPS performance categories on the 2018 reporting period.

One of the major changes is that CMS set the 2018 MIPS final score threshold at 15 points, up from 3 points in 2017. To avoid the 5% penalty, physicians must earn at least 15 MIPS points.

Cost

• Weight to the final score has increased from 0% in 2019 payment year to 10% in 2020 payment year.
• No data submission is required.
• Measures include the Medicare Spending per Beneficiary (MSPB) and Total per Capita Cost.
• CMS is developing new episode-based cost measures for use in subsequent program years.

Quality

• Weight to the final score has decreased from 60% in 2019 payment year to 50% in 2020 payment year.
• In 2018, physicians and groups must submit quality measure data for the full calendar year to be considered full participants in the MIPS program.
• To achieve full credit for the Quality performance category, physicians must achieve a total of 60 or 70 points, depending on practice size. Practices of 15 or fewer providers must report six measures, each with 10 total possible points, while practices 2 of 16 or more providers will also be scored on a claims-based hospital re-admission measure in addition to the 6 reported measures, each worth 10 possible points. Physicians must report on 60% of all patients, if reporting via registry or EHR, and 60% of all Medicare Part B patients if reporting via claims. Physicians must report a minimum of 6 measures, with at least one being an outcome measure, if available. If no outcome measure applies to the clinician, he or she would report one “high priority measure”. Each measure reported must have a minimum of 20 cases to be included in the Quality category score. It means, the denominator for each measure must be at least 20.
• Data Submission. Physicians and groups may report their quality performance data through claims, registry, EHR, or Web Interface (formerly known as GPRO—and only available for groups of 25 or more). Physicians or groups do not need to use the same submission mechanism for every category.

Advancing Care Information

• The base score is 50% and performance score is 50%.
• The base score requires a numerator/denominator or yes/no statement for each required measure. Physicians must report all required measures to receive a base score. If the base score isn’t met, you will get a 0 points for the ACI category.
• In the 2018 performance period, ECs who only utilize 2015 edition certified electronic health record technology (CEHRT) qualify for a 10-point ACI bonus.
• Physicians can submit additional measures to be awarded higher performance score.
• Exclusions/Exceptions. MIPS ECs with fewer than 100 permissible prescriptions during the reporting period; MIPS EC or group who makes less than 100 referrals during the reporting period can be excluded from Health Information Exchange objective; Advancing Care Information category can be reweighted to 0% and relocated to the Quality by automatic reweight or by application.

Improvement Activities

• Weight to final score remains the same, 15%, for 2020 payment year.
• 112 activities are included in the inventory.
• Attest that you completed up to 4 improvement activities for a minimum of 90 days. Medium –weighted activities: 10 points and High –weighted Activities: 20 points. Maximum points for this category: 40 points. No changes from 2017.

To summarize

The performance period for the quality and cost categories is a full calendar year (January 1 - December 31, 2018). The performance period for the improvement activities and advancing care information (ACI) categories is any consecutive 90 days.

Final scores above the threshold will receive a positive payment adjustment.
Final scores below the threshold will receive a negative payment adjustment.
ECs in the lowest quartile will receive the maximum payment adjustment for a performance period.
Final scores equal to the threshold will receive a neutral payment adjustment.

The MIPS 15 points threshold can be met in a variety of ways, such as:

• Full participation in the Improvement Activities category, such as submitting one high-weighted activity or two medium weighted activities for small practices, or two high-weighted activities, four medium-weighted activities, or a combination of both medium- and high-weighted activities;
• The Advancing Care Information (ACI) category base score and one quality measure meeting the measure threshold, or data completeness, but not benchmarks;
• ACI base score and one medium-weighted improvement activity; or
• Six quality measures meeting data completeness, but not measure benchmarks.

MIPS Reporting Options You may report using different mechanisms between categories, but only one method of reporting can be used within each category.

• Medicare Part B claims-based reporting
• Qualified registry
• Certified electronic health record technology (CEHRT)
• Qualified clinical data registry (QCDR)
• CMS Web Interface (for groups of 25 or more eligible clinicians)
• Consumer Assessment of Healthcare Providers and Suppliers (CAHPS) for MIPS (counts as one quality measure; remaining measures must be reported using one other reporting method).

There are some changes in weighting MIPS performance categories. For example, weighting the MIPS Cost performance category to 10% of your total MIPS final score. CMS will calculate cost measure performance; no action is required from clinicians.

References:

https://www.cms.gov
http://go.cms.gov/2cCV17l