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2019 MIPS Performance Information for Quality and Cost Categories

Based on the Final Rule which was published in November 2018 the following is material pertinent to the Quality and Cost categories:

Quality Category

  • The Quality category carries a weight of 45% of your total MIPS score as compared to 50% last year.
  • Claims-based measures can only be submitted by clinicians in a small practice (15 or fewer clinicians). This is the first year that claim submission has been limited by practice size, whether participating individually or as a group.
  • This is the first year the eligible clinicians or groups can mix and match their collection types.

Example, some measures can be sent via EHR and others via QCDR. If the same measure is submitted via multiple collection types, the measure that scores highest will dominate.

Data completeness requirement for 2019 is 60% which is the same as reporting period 2018, with the following scoring change:

  • For groups that submit 5 or fewer quality measures and do not meet the CAHPS for MIPS sampling requirements, the quality denominator will be reduced and the measure will receive zero points.

Topped-Out Measures: The definition and lifecycle for topped out measures remain the same for 2019, although additional factors may affect the time a topped-out measure remains, such as:

  • Extremely Topped-Out Measures: A measure attains extremely topped out status when the average mean performance is within the 98th to 100th percentile range. Such measures may be proposed for removal in the next rule-making cycle, and will not follow the 4-year lifecycle for other topped-out measures.
  • Bonus Points: High-Priority Measures (after first required measure)
  • Same as Year 2, with the exception of CMS Web Interface Reporters
  • CMS also revised the definition of a high priority measure to include opioid-related measures –
    • A high priority measure is an outcome, appropriate use, patient safety, efficiency, patient experience, care coordination, or opioid-related quality measure.
  • Improvement Scoring – Same as 2018, must fully Participate
  • Small Practice Bonus:
  • The small practice bonus will continue in 2019 reporting period but will now be added to the Quality performance category, rather than in the MIPS final score calculation.
  • 6 bonus points are added to the numerator of the Quality performance category for MIPS eligible clinicians in small practices who submit data on at least 1 quality measure.

Cost Category

  • The Cost category carries a weight of 15% of your total MIPS score as compared to 10% last year.
  • The Total Per Capita Cost (TPCC) and Medicare Spending per Beneficiary (MSPB) measures remain the same in 2019 reporting period.
  • CMS will also add 8 new episode-based measures to the Cost performance category
  • Calculating the Cost Score will remain the same as 2018 reporting period.
  • As with last year eligible clinicians do not need to report data for the Cost category as CMS will determine the scoring based on claim submission.

Meridian clients should review these 2 categories to insure that they are reporting appropriately beginning in 2019. Watch for information on the remaining categories – Promoting Interoperability (PI) Performance and Improvement Activities.

If you have any questions regarding this government program please reach out to Meridian for information.