CMS proposes a leaner MIPS for in 2019
Next year, CMS wants the Merit-based Incentive Payment System (MIPS) to be more streamlined, with fewer measures to report, expanded eligibility for non-physician providers to participate, and various tweaks to the four MIPS performance categories.
The provisions appear in the Quality Payment Program (QPP) proposed rule, which CMS has bundled into its Physician Fee Schedule (PFS) proposed rule for 2019. Overall, CMS appears to be continuing a theme it established during the past year, to reduce administrative burden on providers, boost quality measures linked to patient outcomes, and increase healthcare IT interoperability.
Below are a list of highlights from the proposed rule, which should see a final rule released in early November.
- Expanding MIPS eligibility. In 2019, CMS wants to increase the number of provider types eligible to participate in MIPS and other quality programs. The agency proposes adding clinical psychologists, clinical social workers, and physical and occupational therapists as eligible providers. In a separate move, CMS proposes tweaking the low volume threshold (providers are only required to report MIPS data if they see at least 200 Medicare patients or submit a least $90,000 in Part B charges annually) by adding a third threshold, at least 200 Medicare claims billed annually, and allowing providers who meet any two of these thresholds to participate.
- New weights for MIPS categories. CMS would continue to tweak the weighting of MIPS performance categories toward the MIPS composite score, increasing the weight of Cost performance (which CMS calculates automatically based on claims data) from 10% to 15% and offsetting the 5% gain by cutting the weight of the Quality performance category from 50% to 45%. The other categories, Promoting Interoperability (formerly known as Advancing Care Information) and Improvement Activities, would both remain at 15% weighting.
- Removing burdensome quality measures. CMS also proposed removing 34 Quality reporting measures that the agency has found redundant, overly burdensome, or simply ineffective at measuring performance. The proposed rule partially offset the removals by adding 10 quality measures, four of which rely on patient reporting of outcomes.
- Latest EHR certification required. CMS wants providers who report MIPS data to use 2015 edition certified EHRs, putting pressure on those providers currently using the 2014 edition certified software. Upgrading could be costly and may require switching to a new vendor for those EHR systems that are no longer being supported or haven’t received the 2015 certification yet.
CMS Administrator Seema Verma chose to emphasize the greater efficiency that the 2019 QPP proposed rule would bring to the quality reporting process. CMS estimates that if adopted as written, the QPP proposed rule would reduce administrative costs by $2.6 million in 2019 and eliminate 29,305 hours spent on administrative work.