Proposed Rule for the CMS Quality Payment Program in 2020

1. CMS 2020
PROPOSED RULE
Quality Payment Program:

2. KEY
THINGS
TO
KNOW
MIPS 2020

3. Remember, these proposed
changes are not finalized yet.

4. 1
Increasing
Performance
Threshold

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. Also, you must score a minimum of
80 points
To receive the Exceptional Performance bonus money

7. Minimum Scores By Year

8. 2019 Performance Threshold

9. 2020 Performance Threshold

10. 2021 Performance Threshold

11. Penalties & Incentives

12. -9%-0%
For not meeting the minimum score (45)
<9%
For the top performers
What can
you lose,
what can
you gain?

13. 2
Posting
Performance on
Physician Compare

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. 3
Revising
Category
Weights

16. The category weights
have been modified.

17. 2019 2020
Quality:
45%
Cost:
15%
PI:
25%
IA:
15%
Quality:
40%
Cost:
20%
PI:
25%
IA:
15%

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. 2020
QUALITY
CATEGORY
Category weight: 40% Performance Period: 365 days

20. 4
Data
Completeness
Threshold
QUALITY

21. Increasing the data completeness
threshold for all measures.
QUALITY

22. Claims:
70% sample
of your Medicare
Part B patients
If you
submit:
QUALITY

23. All other
measure types:
70% sample
of all patients
across all payers
If you
submit:
(eCQMs, MIPS eCQMs, QCDR measures)
QUALITY

24. 2020
COST
CATEGORY
Category weight: 40% Performance Period: 365 daysCategory weight: 20% Performance Period: 365 days

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. They are revising the TPCC & MSPB
measure specifications
And adding 10 new episode-based
measures
In 2020:
COST

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. 2020
IMPROVEMENT
ACTIVITIES
CATEGORY
Category weight: 40% Performance Period: 365 daysCategory weight: 15% Performance Period: 90 days

29. One significant change:
You might be used to having one clinician
carry a group, this changes in 2020.
IA

30. At least 50%
of your group
must attest to completing
the improvement activity
for 90 days
Group
Participation
IA
IA

31. • Addition
of 2 new Improvement Activities
• Modification
of 7 existing Improvement Activities
• Removal
of 15 existing Improvement Activities
Measure
Changes
IA
IA

32. 5
Definition
of Rural Area
IA

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. 6
Patient-Centered
Medical Homes
Accreditation
IA

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. 2020
PROMOTNG
INTEROPERABILITY
CATEGORY
Category weight: 40% Performance Period: 365 daysCategory weight: 25% Performance Period: 90 days

37. There are very few changes
for this category.
PI

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. In 2020, that goes down to 75% of
your group muse meet that
definition.
Category
changes
PI
PI

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