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2020 MIPS Proposed Rule: Key Highlights

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A slideshow featuring highlights of the 2020 proposed changes to the MIPS program.

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2020 MIPS Proposed Rule: Key Highlights

  1. 1. CMS 2020 PROPOSED RULE Quality Payment Program:
  2. 2. KEY THINGS TO KNOW MIPS 2020
  3. 3. Remember, these proposed changes are not finalized yet.
  4. 4. 1 Increasing Performance Threshold
  5. 5. The performance threshold will increase from: 30 points to 45 points That means in 2020, Eligible Clinicians would need to score at least 45 points to avoid a penalty.
  6. 6. Also, you must score a minimum of 80 points To receive the Exceptional Performance bonus money
  7. 7. Minimum Scores By Year
  8. 8. 2019 Performance Threshold
  9. 9. 2020 Performance Threshold
  10. 10. 2021 Performance Threshold
  11. 11. Penalties & Incentives
  12. 12. -9%-0% For not meeting the minimum score (45) <9% For the top performers What can you lose, what can you gain?
  13. 13. 2 Posting Performance on Physician Compare
  14. 14. They will post it as soon as it’s available (late 2019), as soon as they can technically get it done. They will post your aggregate MIPS score, but include the minimum, maximum and final scores. CMS will post your 2018 performance on Physician Compare
  15. 15. 3 Revising Category Weights
  16. 16. The category weights have been modified.
  17. 17. 2019 2020 Quality: 45% Cost: 15% PI: 25% IA: 15% Quality: 40% Cost: 20% PI: 25% IA: 15%
  18. 18. 2019 2020 Quality: 45% Cost: 15% PI: 25% IA: 15% Quality: 40% Cost: 20% PI: 25% IA: 15% 2021 2022 Quality: 35% Cost: 25% PI: 25% IA: 15% Quality: 30% Cost: 30% PI: 25% IA: 15%
  19. 19. 2020 QUALITY CATEGORY Category weight: 40% Performance Period: 365 days
  20. 20. 4 Data Completeness Threshold QUALITY
  21. 21. Increasing the data completeness threshold for all measures. QUALITY
  22. 22. Claims: 70% sample of your Medicare Part B patients If you submit: QUALITY
  23. 23. All other measure types: 70% sample of all patients across all payers If you submit: (eCQMs, MIPS eCQMs, QCDR measures) QUALITY
  24. 24. 2020 COST CATEGORY Category weight: 40% Performance Period: 365 daysCategory weight: 20% Performance Period: 365 days
  25. 25. Total Per Capita Cost (TPCC) Medicare Spending Per Beneficiary (MSPB) 8 episode-based measures In 2019, CMS will consider the following for Cost: COST
  26. 26. They are revising the TPCC & MSPB measure specifications And adding 10 new episode-based measures In 2020: COST
  27. 27. 1. Acute Kidney Injury Requiring New Inpatient Dialysis 2. Elective Primary Hip Arthroplasty 3. Femoral or Inguinal Hernia Repair 4. Hemodialysis Access Creation 5. Inpatient Chronic Obstructive Pulmonary Disease (COPD) Exacerbation 6. Lower Gastrointestinal Hemorrhage 7. Lumbar Spine Fusion for Degenerative Disease, 1-3 Levels 8. Lumpectomy Partial Mastectomy, Simple Mastectomy 9. Non-Emergent Coronary Artery Bypass Graft (CABG) 10. Renal or Ureteral Stone Surgical Treatment 10 new episode- based measures COST COST
  28. 28. 2020 IMPROVEMENT ACTIVITIES CATEGORY Category weight: 40% Performance Period: 365 daysCategory weight: 15% Performance Period: 90 days
  29. 29. One significant change: You might be used to having one clinician carry a group, this changes in 2020. IA
  30. 30. At least 50% of your group must attest to completing the improvement activity for 90 days Group Participation IA IA
  31. 31. • Addition of 2 new Improvement Activities • Modification of 7 existing Improvement Activities • Removal of 15 existing Improvement Activities Measure Changes IA IA
  32. 32. 5 Definition of Rural Area IA
  33. 33. The definition of a rural area will now be based on FORHP’s most recent list of eligible ZIP codes. (FORHP: Federal Office of Rural Health Policy) IA
  34. 34. 6 Patient-Centered Medical Homes Accreditation IA
  35. 35. CMS is proposing to open up the ways in which an organization could become a PCMH. More accredited organizations could certify you as a PCMH. IA
  36. 36. 2020 PERFORMANCE IMPROVEMENT CATEGORY Category weight: 40% Performance Period: 365 daysCategory weight: 25% Performance Period: 90 days
  37. 37. There are very few changes for this category. PI
  38. 38. In 2019, if you wanted this category reweighted (meaning your PI category weight would go to 0 and your Quality category weight would increase to 70) your group must have 100% of the clinicians meeting the CMS definition of a hospital-based clinician. Category changes PI PI
  39. 39. In 2020, that goes down to 75% of your group muse meet that definition. Category changes PI PI
  40. 40.  www.medisolv.com | info@medisolv.com | 443-539-0505 © 2019 Medisolv, Inc. All rights reserved.

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