CMS QPP Proposed Rule 2020
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The proposed rule outlines several changes to the Quality Payment Program for 2020: 1. The MIPS performance threshold will increase from 30 to 45 points, meaning clinicians need to score at least 45 points to avoid a penalty. The top bonus is awarded at 80 points. 2. CMS will post 2018 MIPS performance scores on Physician Compare in late 2019. Scores will include minimum, maximum and final scores. 3. Category weights have been adjusted, with Quality decreasing from 45% to 40% and Cost increasing from 15% to 20% for 2020. 4. Data completeness thresholds are increasing for quality measures to 70% of patients.
CMS QPP Proposed Rule 2020
- 1. CMS 2020 PROPOSED RULE Quality Payment Program:
- 3. Remember, these proposed changes are not finalized yet.
- 5. 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.
- 6. Also, you must score a minimum of 80 points To receive the Exceptional Performance bonus money
- 7. Minimum Scores By Year
- 12. -9%-0% For not meeting the minimum score (45) <9% For the top performers What can you lose, what can you gain?
- 14. They will post it as soon as it’s available (late 2019), as soon as they can technically get it done. They will post your aggregate MIPS score, but include the minimum, maximum and final scores. CMS will post your 2018 performance on Physician Compare
- 16. The category weights have been modified.
- 19. 2020 QUALITY CATEGORY Category weight: 40% Performance Period: 365 days
- 21. Increasing the data completeness threshold for all measures. QUALITY
- 22. Claims: 70% sample of your Medicare Part B patients If you submit: QUALITY
- 23. All other measure types: 70% sample of all patients across all payers If you submit: (eCQMs, MIPS eCQMs, QCDR measures) QUALITY
- 24. 2020 COST CATEGORY Category weight: 40% Performance Period: 365 daysCategory weight: 20% Performance Period: 365 days
- 25. Total Per Capita Cost (TPCC) Medicare Spending Per Beneficiary (MSPB) 8 episode-based measures In 2019, CMS will consider the following for Cost: COST
- 26. They are revising the TPCC & MSPB measure specifications And adding 10 new episode-based measures In 2020: COST
- 27. 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
- 28. 2020 IMPROVEMENT ACTIVITIES CATEGORY Category weight: 40% Performance Period: 365 daysCategory weight: 15% Performance Period: 90 days
- 29. One significant change: You might be used to having one clinician carry a group, this changes in 2020. IA
- 30. At least 50% of your group must attest to completing the improvement activity for 90 days Group Participation IA IA
- 31. • Addition of 2 new Improvement Activities • Modification of 7 existing Improvement Activities • Removal of 15 existing Improvement Activities Measure Changes IA IA
- 33. The definition of a rural area will now be based on FORHP’s most recent list of eligible ZIP codes. (FORHP: Federal Office of Rural Health Policy) IA
- 35. CMS is proposing to open up the ways in which an organization could become a PCMH. More accredited organizations could certify you as a PCMH. IA
- 36. 2020 PROMOTNG INTEROPERABILITY CATEGORY Category weight: 40% Performance Period: 365 daysCategory weight: 25% Performance Period: 90 days
- 37. There are very few changes for this category. PI
- 38. 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
- 39. In 2020, that goes down to 75% of your group muse meet that definition. Category changes PI PI
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