All

MIPS 2019

Payer Contract Negotiations
13 Mar

MIPS 2019

What are the categories for MIPS 2019 reporting and how are they weighted?

  • Quality – 45 points
    • Weighted from 50% to 45%
    • Many benchmarks changed
    • Multiple measures were removed and many standard measures given a seven-point-cap
  • Promoting Interoperability – 25 points
    • Moved from “MU Stage 2 Modified” to “MU Stage 3”
    • Multiple measures removed
    • New measures added, which require significant resources and planning
  • Improvement Activities – 15 points
    • Some measures added
    • CEHRT bonus removed
    • Numerous updates to current measures and new measures added
  • Cost – 15 points
    • Weighted up from 10% to 15%
    • New procedure-based measures added

Will it be more challenging for small clinics to participate and achieve maximum incentives in 2019?

Yes, CMS increased the exceptional performance threshold to 75-points versus 70-points in 2018.

Below are some of the category updates that will make reaching the 75-point threshold more difficult, especially for smaller organizations with fewer resources:

  • Multiple Quality measures removed
  • Quality benchmarks updated with more difficult-to-report measures
  • Most Promoting Interoperability bonus measures removed

What is a topped-out measure?

The performance on the measure is high and unvarying across the board, so meaningful distinctions and improvements can no longer be made. When a measure reaches a topped-out status, the measure could be removed unless it’s a QCDR measure which is excluded from the removal process.

What is a Quality measure decile?

The decile refers to the number of points that a measure can receive for a given performance. The decile can also vary depending on the chosen reporting method.

What is the financial impact of MIPS?

Your 2019 payments are impacted by what you reported in 2017, and what you report in 2019 will impact your 2021 payments.

Performance Year

Payment Year

Penalty

Exceptional Performance Score Threshold

Maximum Incentive

2017

2019

-4%

15

1.88%

2018

2020

-5%

70

2.05%

2019

2021

-7%

75

3.58%

2020

2022

-9%

TBD

TBD

2021

2023

-9%

TBD

TBD

2022

2024

-9%

TBD

TBD

By: Tiffany Short, Director of Consulting Services.