A slideshow of the MIPS 2021 requirements as outlined in the PFS Final Rule.

1. CHANGES
TO THE
FINAL RULE
MIPS:
2021

2. KEY
THINGS
TO
KNOW
MIPS 2021

3. 1
Increasing
Performance
Threshold

4. The performance threshold
will increase from:
45 points to 60 points
That means in 2021, Eligible Clinicians would need to
score at least 60 points to avoid a penalty.

5. Also, the Exceptional Performance
Threshold increases to
85 points
The minimum score to receive the
Exceptional Performance bonus money
Note: 2022 is the last year for the bonus money.

6. Minimum Scores By Year

7. 2020 Performance Threshold

8. 2021 Performance Threshold

9. Penalties & Incentives

10. -9%-0% fee schedule reduction
For not meeting the minimum score
Up to 9% increase in fee schedule
For the top performers
What can
you lose,
what can
you gain?

11. 2
Posting
Performance on
Physician Compare

12. CMS will post scores as soon as they
are available or as soon as they can
technically get it done.
They will post your aggregate MIPS
score and include the minimum,
maximum and final scores.
Your 2018
performance
posted on
Physician
Compare

13. 3
Revising
Category
Weights

14. 2020
Quality:
45%
Cost:
15%
PI:
25%
IA:
15%

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

16. By law, the Cost and Quality categories
must be equally weighted at 30%
by the 2022 performance period.

17. 3
New
Performance
Pathway

18. For MIPS eligible clinicians
participating in a MIPS APM the APP is
available in 2021.
The APP is required for Medicare
Shared Savings Program ACOs.
The pathway is comprised of a fixed set
of measures for each category.
APM
Performance
Pathway
(APP)

19. The APP has different scoring weights
than the traditional MIPS scoring.
APM
Performance
Pathway
(APP)

20. Traditional MIPS APP
Quality:
50%
PI:
30%
IA:
20%
Cost:
20%
Quality:
40%PI:
25%
IA:
15%

21. CMS said they were taking away the
ability to submit via the CMS Web
Interface Reporting option in 2021, but
instead they are allowing it for one
more year.
The CMS Web Interface Reporting
option will be sunset in 2022.
CMS
Web Interface
Reporting
Method

22. 2021
QUALITY
CATEGORY
Category weight: 40% Performance Period: 365 days

23. Changes to Measures
113 had changes
7 had significant enough changes
that don’t allow for comparison with
historical data.
Quality
Category
Measures 209 quality measures for 2021
QUALITY

24. Changes to Measures
Removal of 11 quality measures
Including the All-Cause Hospital
Readmission Measure
Quality
Category
Measures 209 quality measures for 2021
QUALITY

25. Changes to Measures
Addition of 2 claims quality measures
Including:
• Hospital-Wide, 30-Day,All-Cause Unplanned Readmission
(HWR) Rate
• 200 case minimum
• 1-year measurement period
• Only applies to groups, and virtual groups, andAPM Entities
with 16 or more clinicians and that meet the case minimum
Quality
Category
Measures 209 quality measures for 2021
QUALITY

26. Changes to Measures
Addition of 2 claims quality measures
Including:
• Risk-standardized complication rate (RSCR) following elective
primary total hip arthroplasty (THA) and/or total knee
arthroplasty (TKA)
• 25 case minimum
• 3-year measurement period
• Applies to individual clinicians, groups and virtual groups that meet the
case minimum
Quality
Category
Measures 209 quality measures for 2021
QUALITY

27. 2021
COST
CATEGORY
Category weight: 40% Performance Period: 365 daysCategory weight: 20% Performance Period: 365 days

28. Total Per Capita Cost (TPCC)
Medicare Spending Per Beneficiary (MSPB)
18 episode-based measures
No changes to measures
COST

29. CMS is adding telehealth services
directly applicable to existing episode-
based cost measures and TPCC
measure.
In 2021:
COST

30. 2021
IMPROVEMENT
ACTIVITIES
CATEGORY
Category weight: 40% Performance Period: 365 daysCategory weight: 15% Performance Period: 90 days

31. No significant changes in 2021.
IA

32. 2021
PROMOTING
INTEROPERABILITY
CATEGORY
Category weight: 40% Performance Period: 365 daysCategory weight: 25% Performance Period: 90 days

33. CMS is keeping the:
Query of Prescription Drug Monitoring
Program (PDMP) measure as an optional measure
(available for 10 bonus points)
New optional HIE bi-directional exchange measure:
Alternate to reporting the two existing
measures under the HIE objective.
PI

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