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2020 MIPS Performance Weight

2020 being the 4th performance year of MIPS, CMS has not changed the weight for any categories from last year. They stand as mentioned below.

The weight for Quality, PI, IA & Cost remains the same at 45%, 25%,15% and 15% respectively.

Performance category

Performance Category
Quality
Quality Reporting Requirements

Criteria

MIPS Quality

Group Submission

Measure group submission is not allowed, instead Physicians Groups can use specialty measure sets applicable to their group during submission to ensure simplicity in reporting.

Submission Eligibility

  • Eligible clinicians can submit from the specialty measure set.
  • Groups can also submit their applicable measure sets or select the best applicable measures.

Submission Criteria

  • Individuals and Groups have to report 6 measures including one outcome measure or a high priority.
  • If specialty specific measure set has fewer than 6 measures, eligible clinicians have to report for all the applicable measures.

Data Completeness Criteria

MIPS eligible clinicians have to submit data on at least 70 percent of the MIPS eligible clinicians or group’s patient’s data regardless of the payer.

Case Volume

Minimum 20 patients per measure is required.

Performance Criteria

Quality measures submitted for the 2020 performance period will receive between 0 and 10 points as measure achievement points.
Quality measures fall into one of three categories for scoring:

  • Between 3 and 10 Points: The measure meets the data completeness criteria, has a benchmark, and the volume of cases is sufficient (> 20 cases for most measures). These measures continue to receive between 3 to 10 points based on performance compared to the benchmark.
  • 3 Points: The measure meets the data completeness criteria but either (1) doesn’t have a benchmark and/or (2) the volume of cases you’ve submitted is insufficient (<20 cases for most measures). These measures continue to receive 3 measure achievement points.
  • 0 Point:The measure doesn’t meet the data completeness criteria, which varies by collection type. These measures receive 0 point, except for small practices which would continue to receive 3 measure achievement points.

Mutiple Collection Types (Separate Criteria)

  • In Year 4, groups and virtual groups can submit measures via multiple collection types (MIPS CQM, eCQM, QCDR measures, CMS Web Interface measures for large practices, and Medicare Part B claims measures for small practices)
  • If the same measure is submitted via multiple collection types, the one with the greatest number of measure achievement points will be selected for scoring
  • EXCEPTION: CMS Web Interface measures cannot be scored with other collection types other than CMS approved survey vendor measure for CAHPS for MIPS and/or administrative claims measures.

Reporting Requirements

Quality
Quality Reporting Requirements

Criteria

MIPS Quality

Group Submission

Measure group submission is not allowed, instead Physicians Groups can use specialty measure sets applicable to their group during submission to ensure simplicity in reporting.

Submission Eligibility

  • Eligible clinicians can submit from the specialty measure set.
  • Groups can also submit their applicable measure sets or select the best applicable measures.

Submission Criteria

  • Individuals and Groups have to report 6 measures including one outcome measure or a high priority.
  • If specialty specific measure set has fewer than 6 measures, eligible clinicians have to report for all the applicable measures.

Data Completeness Criteria

MIPS eligible clinicians have to submit data on at least 70 percent of the MIPS eligible clinicians or group’s patient’s data regardless of the payer.

Case Volume

Minimum 20 patients per measure is required.

Performance Criteria

Quality measures submitted for the 2020 performance period will receive between 0 and 10 points as measure achievement points.
Quality measures fall into one of three categories for scoring:

  • Between 3 and 10 Points: The measure meets the data completeness criteria, has a benchmark, and the volume of cases is sufficient (> 20 cases for most measures). These measures continue to receive between 3 to 10 points based on performance compared to the benchmark.
  • 3 Points: The measure meets the data completeness criteria but either (1) doesn’t have a benchmark and/or (2) the volume of cases you’ve submitted is insufficient (<20 cases for most measures). These measures continue to receive 3 measure achievement points.
  • 0 Point: The measure doesn’t meet the data completeness criteria, which varies by collection type. These measures receive 0 point, except for small practices which would continue to receive 3 measure achievement points.

Mutiple Collection Types (Separate Criteria)

  • In Year 4, groups and virtual groups can submit measures via multiple collection types (MIPS CQM, eCQM, QCDR measures, CMS Web Interface measures for large practices, and Medicare Part B claims measures for small practices)
  • If the same measure is submitted via multiple collection types, the one with the greatest number of measure achievement points will be selected for scoring
  • EXCEPTION: CMS Web Interface measures cannot be scored with other collection types other than CMS approved survey vendor measure for CAHPS for MIPS and/or administrative claims measures.

What’s New with Quality in 2020?

  • Established flat benchmark for MIPS #1 (Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%)) and MIPS#236 (Controlling High Blood Pressure)
  • We will use flat benchmarks for scoring the Medicare Part B claims and MIPS Clinical Quality Measure (CQM) collection types of these measures, as the historical, performance-based benchmarks may potentially incentivize treatment that may be inappropriate for the patient.
  • We will use historical, performance-based benchmarks for scoring the Electronic Clinical Quality Measure (eCQM) versions of these measures.
  • Added new specialty sets.
  • Seven new specialty sets were established for Speech Language Pathology, Audiology, Clinical Social Work, Chiropractic Medicine, Pulmonology, Nutrition/Dietician, and Endocrinology.
  • Note: Clinical Social Workers are not a MIPS eligible clinician type at this time.
PI Reporting

PI Reporting Requirements

CMS has made only a few changes to the MIPS PI Reporting Requirements for 2020. The key requirements for MIPS PI reporting requirements are as listed below:

Promoting Interoperability
changes in 2020

PI Reporting Requirements

Promoting Interoperability

Previously known as ACI Incentive Program, also known as Meaningful Use.

What’s New with (PI) Promoting Interoperability in 2020?

  • Groups and virtual groups qualify for automatic reweighting of this performance category when more than 75% of the clinicians in the group or virtual group are hospital-based.
  • CMS has removed the Verify Opioid Treatment Agreement measure.
  • The optional Query of Prescription Drug Monitoring Program (PDMP) measure requires a yes/no response instead of a numerator and denominator.
  • CMS has finalized this for both the 2019 and 2020 performance periods in the Calendar Year (CY) 2020 QPP Final Rule.
IA Reporting

IA Reporting Requirements

CMS has made only a few changes to the MIPS IA Reporting Requirements for 2020. The key requirements for MIPS IA reporting requirements are as listed below:

The Improvement Activities (IA) performance category focuses on one of the MIPS strategic goals, to use a patient-centered approach to program development that leads to better, smarter, and healthier care

For the performance year 2020, New Improvement Activities are finalized and previously adopted improvement activities have been updated along with the removal of a few existing activities

MIPS would reward Improvement Activities falling into Care coordination, Beneficiary engagement, and Patient safety sub-categories which MIPS eligible clinicians could select from a list of approximately 105 activities

Beginning with 2020, MIPS performance period, participants no longer require self-identifications for non-patient facing MIPS eligible clinicians, small practices, practices located in rural areas or geographic HPSA

MIPS eligible clinicians or groups can simply attest to activities performed for a continuous 90 day period and qualify for reward in IA category

What’s New with (IA) Improvement Activities in 2020?

CMS has increased the performance threshold for groups and virtual groups to attest to an activity:

  • At least 50% of the clinicians (in the group or virtual group) must perform the same activity during any continuous 90-day period, or as specified in the activity description, within the same performance period.
  • We clarified patient-centered medical home designation by removing specific examples of entity names of accreditation organizations or comparable specialty practice programs.
  • We concluded the CMS Study on Factors Associated with Reporting Quality Measures. This study is no longer available for credit in the Improvement Activities performance category.
cost Reporting

Cost Reporting Requirements

CMS included Cost category in the MIPS final score in PY 2020. Cost Performance Category has a weight of 15% in the MIPS Final Score for 2020 performance period. No reporting is required for this category as CMS will be calculating this on their end.

  • Cost performance category reporting period will be for the full performance year in 2020.
  • Individual eligible clinicians or groups will be scored on Twenty measures included in the Cost performance category for 2020 MIPS Performance period.
  • Medicare Spending per Beneficiary (MSPB), Total per Capita Cost measure for all attributed beneficiaries (TPCC) and Eighteen episode-based cost measures.
  • CMS will calculate Cost category score based on Administrative claims data.
  • Individual MIPS eligible clinicians and groups don’t have to submit any other information for the Cost performance category.

What’s New with Cost in 2020?

CMS has increased the performance threshold for groups and virtual groups to attest to an activity:

  • Revised Medicare Spending Per Beneficiary measure.
  • Updated name – Medicare Spending Per Beneficiary Clinician (MSPB-C) measure.
  • Refined attribution methodology for medical and surgical episodes.
  • Service exclusions for costs that are unlikely to be influenced by clinicians.
  • Revised Total Per Capita Cost (TPCC) measure.
  • Refined attribution methodology for identifying primary care relationships.
  • Specialty exclusions for clinicians who don’t provide primary care services.
  • Refined risk adjustment to account for changes in patient health status during the year.
  • Added 10 new Episode-based cost measures