2020 QPP Final Rule
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The 2020 Quality Payment Program Final Rule makes several changes including: 1. Increasing the MIPS performance threshold from 30 to 45 points to avoid a penalty and increasing the exceptional performance threshold from 80 to 85 points. 2. CMS will post 2018 MIPS performance scores on Physician Compare in late 2019 and include minimum, maximum, and final scores. 3. Category weights remain the same for 2020 but must be equally weighted between cost and quality by 2022. 4. The data completeness threshold increases to 70% for all quality measures.
2020 QPP Final Rule
- 1. 2020 FINAL RULE Quality Payment Program:
- 4. The performance threshold will increase from: 30 points to 45 points That means in 2020, Eligible Clinicians would need to score at least 45 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 CMS had proposed the bonus threshold score to be 80 points, but decided to up that to 85 points.
- 6. Minimum Scores By Year
- 11. -9%-0% fee schedule reduction For not meeting the minimum score (45) Up to 9% increase in fee schedule For the top performers What can you lose, what can you gain?
- 13. CMS will post scores as soon as they are available (late 2019), 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
- 15. The category weights have NOT been modified for 2020.
- 16. 2019 & 2020 Quality: 45% Cost: 15% PI: 25% IA: 15% CMS was supposed to up Cost to 20% and lower Quality to 40% but they decided to keep the weighting the same as 2019.
- 17. But by law, the Cost and Quality categories must be equally weighted at 30% by the 2022 performance period.
- 18. 2020 QUALITY CATEGORY Category weight: 45% Performance Period: 365 days
- 20. The data completeness threshold has increased to 70% for all measures. QUALITY
- 21. Claims: 70% sample of your Medicare Part B patients If you submit: QUALITY
- 22. All other measure types: 70% sample of all patients across all payers If you submit: eCQMs, MIPS CQMs (Registry), QCDR measures QUALITY
- 23. 2020 COST CATEGORY Category weight: 40% Performance Period: 365 daysCategory weight: 15% Performance Period: 365 days
- 24. Total Per Capita Cost (TPCC) Medicare Spending Per Beneficiary (MSPB) 8 episode-based measures In 2019, CMS evaluates your performance for these measures for Cost: COST
- 25. CMS will maintain the existing 8 episode-based measures and add 10 new episode-based measures CMS has also revised the TPCC & MSPB measure specifications In 2020: COST
- 26. 1. Acute Kidney Injury Requiring New Inpatient Dialysis 2. Elective Primary Hip Arthroplasty 3. Femoral or Inguinal Hernia Repair 4. Hemodialysis Access Creation 5. Inpatient Chronic Obstructive Pulmonary Disease (COPD) Exacerbation 6. Lower Gastrointestinal Hemorrhage 7. Lumbar Spine Fusion for Degenerative Disease, 1-3 Levels 8. Lumpectomy Partial Mastectomy, Simple Mastectomy 9. Non-Emergent Coronary Artery Bypass Graft (CABG) 10. Renal or Ureteral Stone Surgical Treatment 10 new episode-based measures COST COST
- 27. 2020 IMPROVEMENT ACTIVITIES CATEGORY Category weight: 40% Performance Period: 365 daysCategory weight: 15% Performance Period: 90 days
- 28. One significant change: You might be used to having one clinician carry a group. This changes in 2020. IA
- 29. At least 50% of your group must attest to completing the same improvement activity for 90 consecutive days. The activities may be completed anytime within the calendar year. Group Participation IA IA
- 30. • Addition of 2 new Improvement Activities • Modification of 7 existing Improvement Activities • Removal of 15 existing Improvement Activities Measure Changes IA IA
- 32. CMS is opening up the ways in which an organization could become a PCMH. More accredited organizations could certify you as a PCMH. IA
- 33. 2020 PROMOTING INTEROPERABILITY CATEGORY Category weight: 40% Performance Period: 365 daysCategory weight: 25% Performance Period: 90 days
- 34. CMS is including the measure: Query of Prescription Drug Monitoring Program (PDMP) measure as an optional measure (available for bonus points) They are removing the measure: Verify Opioid Treatment Agreement PI
- 35. In 2019, if you wanted this category reweighted (meaning your PI category weight would go to 0 and your Quality category weight would increase to 70) your group must have 100% of the clinicians meeting the CMS definition of a hospital-based clinician. Category changes PI PI
- 36. In 2020, the requirement goes down. Only 75% of your group must meet the hospital-based clinician definition to qualify for re-weighting of PI. Category changes PI PI
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