The proposed 2021 Quality Payment Program includes: 1) No new MIPS Value Pathways program; 2) An APM Performance Pathway reporting option for MIPS APM participants; 3) Increasing the MIPS performance threshold to 50 points to avoid a penalty; 4) Revising category weights with Quality decreasing to 40% and Cost increasing to 20%; 5) Modifications to Quality measures including benchmark adjustments and removing/changing measures.

1. CMS 2021
PROPOSED RULE
Quality Payment Program:

2. Key
things
to know
MIPS 2021

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

4. 1
General Program Changes

5. No MVPs
Program
CMS is not
implementing the
MIPS Value
Pathways (MVPs)
program in 2021.

6. APP
Reporting
Option
§ CMS is proposing a
new APM
Performance Pathway
(APP) reporting option
available only to
participants in MIPS
APMs.
§ Quality measures
reported through the
APP are automatically
used for the Medicare
Shared Savings
Program quality
scoring, satisfying the
requirements for both
programs.

7. 2
Increasing Performance Threshold

8. The performance threshold
will increase from:
It was supposed to go
up to 60 points, but
they changed it.
Eligible Clinicians
need to score at least
50 points to avoid a
penalty in 2021.
45 points to 50 points

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

10. Minimum Scores By Year

11. 2020 Performance Threshold

12. 2021 Performance Threshold

13. Penalties & Incentives

14. -9%-0%
For not meeting the
minimum score (45)
<9%
For the top
performers
What can you lose,
what can you gain?

15. 3
Revising Category Weights

16. The category weights have
been modified.

17. 2020 2021
Quality:
45%
Cost:
15%
PI:
25%
IA:
15%
Quality:
40%
Cost:
20%
PI:
25%
IA:
15%

18. 2020
Quality:
45%
Cost:
15%
PI:
25%
IA:
15%
Quality:
40%
Cost:
20%
PI:
25%
IA:
15%
2021 2022
Quality:
30%
Cost:
30%
PI:
25%
IA:
15%

19. 4
Modifications to the
Category Requirements

20. 2021
Quality
Category
Category weight: 40% Performance Period: 365 days
Quality

21. Quality
Remove the CMS Web
Interface Submission Option

22. Clinicians may submit only eCQMs, MIPS CQMs,
QCDR measures or Claims measures (individuals only).
Quality

23. Quality
Measures
Benchmark Adjustment:
Because of COVID-19, CMS
will use the data submitted in
2021 to calculate the national
quality measure benchmark
rather than the baseline
period historic data.
Quality

24. Quality
Measures
Measure Adjustment:
§ Removing 14 quality measures
§ Significantly change 112
existing MIPS quality measures
§ Add 2 claims outcome
measures
§ Hospital-Wide, 30-Day, All-Cause Unplanned
Readmission (HWR) Rate
§ Risk-standardized complication rate (RSCR)
following elective primary total hip
arthroplasty (THA) and/or total knee
arthroplasty (TKA)
Quality

25. Quality
Measures
ACOs:
There is a separate proposal that would
require ACOs participating in the
Shared Savings Program to report their
quality measures through the APM
Performance Pathway (APP).
The quality measures reported through
the APP would also count for the MIPS
Quality category.
Under the proposed redesign, if the
quality performance standard is met,
the ACO would receive the maximum
sharing rate.
Quality

26. 2021
Cost
Category
Category weight: 20% Performance Period: 365 days
Cost

27. Cost
Like 2020, CMS will use
these measures for Cost:
§ Total Per Capita
Cost (TPCC)
§ Medicare
Spending Per
Beneficiary
(MSPB)
§ 18 episode-
based measures

28. Cost
In 2021:
§ CMS is adding
telehealth
services for the
coordinating
episode-based
measures and
the TPCC
measure.

29. 2021
Improvement
Activities
Category
Category weight: 15% Performance Period: 90 days
Improvement
Activities

30. No significant changes to this category.
Improvement
Activities

31. 2021
Promoting
Interoperability
Category
Category weight: 25% Performance Period: 90 days
Promoting
Interoperability

32. There are very few changes
for this category.
Promoting
Interoperability

33. PI
Category
Category Changes
§ CMS is keeping the Query
of PDMP measure and
making it worth 10 bonus
points.
§ CMS is adding an
additional HIE (health
information exchange)
bidirectional measure.
Promoting
Interoperability

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