BREAKING NEWS: CMS Releases the 2020 MIPS Proposed Rule!

CMS released the 2020 proposed rule for the MIPS program yesterday. Here are the key details:

Performance Threshold

• CMS proposes to increase the performance threshold to 45 points in 2020 and 60 points in 2021. It is currently 30 points for the 2019 performance year.

Exceptional Performance Threshold

• CMS proposed to increase the exceptional performance threshold to 80 points in 2020 and 85 points in 2021. It is currently set at 75 points in 2019.

Don’t Forget:

CMS is  mandated by law to set the performance thresholds at the mean or median of clinician performance by 2022.  What this means is by 2022, the performance threshold must be high enough that 50% of provider payments must include penalties, and 50% of provider payments must include bonuses.

MIPS Category Changes

Cost and Quality Categories

• CMS proposes to drop the quality category from 45% to 40% in 2020, and again to 35% in 2021. Quality will decrease down to 30% in 2022; the cost category will take on the 5% each year, eventually topping out at 30% in 2022, equal to the quality category.
• Along with the changes to weights, the cost and quality categories may also see refined measures, as proposed.
• A proposed increase in quality data completeness from 60% to 70% sample of clinician’s or group’s patients across all payers in the performance year.

Improvement Activities

CMS is proposing changes to the improvement activity category by:

• Changing the activity inventory
• Requiring at least 50% of a group to participate in the activity in order to report as a group [currently only a single clinician must participate on behalf of the entire group]

Promoting Interoperability

No significant proposed changes.

Totally New! MVPs

Coming 2021, CMS introduced a new participation framework called MIPS Value Pathways (MVPs). The goal of MVP is to ensure clinicians/groups are finding the MIPS program to be a meaningful and useful effort, rather than a siloed and irrelevant program. Participants would be in a designated MVP based on their specialty or a specific condition, where measures and activities are interrelated and aligned across the 4 MIPS categories.

Stay tuned for more 2020 MIPS updates including an in-depth analysis of the proposed rule!