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2019 MACRA/MIPS Update: Where Are We Now?

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April 11, 2019

2019 MACRA/MIPS Update: Where Are We Now?

Jennifer Morency

Last year, 2018, was the first year where the obligation to use a 2015 Edition Certified EHR technology (CEHRT) was introduced under MIPS. Certain categories, such as Promoting Interoperability, only required this obligation for part of the year. 

Calendar year 2019, on the other hand, will require healthcare professionals to attest to all categories using a 2015 Edition CEHRT for the entire year.

What Changes Have Been Made in 2019?

Increased Scope of Eligible Clinicians

Eligible clinicians in MIPS Year 1 (2017) and 2 (2018) included:

  • Physicians
  • Physician assistants
  • Nurse practitioners
  • Clinical nurse specialists
  • Certified nurse anesthetists

For Year 3 (2019) of MIPS, however, the list of eligible clinicians has expanded to include:

  • Physical therapists
  • Occupational therapists
  • Qualified speech-language pathologists
  • Qualified audiologists
  • Clinical psychologists
  • Registered dietitian or nutrition professionals

Higher Thresholds

Year 1 of MIPS required eligible clinicians to earn at least 3 points out of a possible 100, with Year 2 requiring 15 points. This year, however, the threshold has significantly jumped, requiring clinicians to score at least 30 MIPS points to receive a neutral payment adjustment.

Clinicians aiming to score bonus performance scores needed to earn 70 MIPS points in 2018. For Year 3, they now need to score at least 75 MIPS points.

Although CMS has raised the performance threshold for 2019, they also announced that there would be higher payment adjustments for 2021. Specifically, 2019, based on 2017 performance, will have a maximum possible (+/-) payment adjustment of 4%, with 2020, based on 2018 performance, having a maximum of 5%. As for the year 2021, based on this year’s performance, the maximum possible (+/-) payment adjustment will be 7%.

Reconfiguration of Promoting Interoperability Category

Many significant changes will be made to the Promoting Interoperability category for Year 3 of MIPS. Having changed names in Year 2 from Advancing Care Information to Promoting Interoperability, this category is also going through the following reconfigurations in Year 3:

  • Obligation to use a 2015 CEHRT
  • Performance-based scoring methodology
  • Addition of two new e-Prescribing objective measures

    • Verify Opioid Treatment Agreement
    • Query of Prescription Drug Monitoring Program (PDMP)

  • Requirement to report to four obligatory MIPS objectives

    • Health Information Exchange
    • Provider to Patient Exchange
    • Public Health and Clinical Data Exchange
    • E-Prescribing

Another required measure, although not weighted, will be Security Risk Analysis.

How is MIPS Weighted in 2019?

For Year 3, 2018 performance year, only two of four MIPS categories have changed weights. Quality has gone from a scoring weight of 50% to 45%, with Cost changing from 10% to 15%.

As for the year 2019, CMS has added eight new Quality measures and removed 26 measures. These were measures CMS qualified as duplicative or topped out.

How Can You Prepare for the Changes?

It is possible for eligible clinicians to prepare for the changes to come and increase their potential for a higher payment adjustment, or at least a neutral one. Here are a couple of ways to do so:

Utilize the Right Technology

Although using a 2015 CEHRT in Year 2 gave eligible clinicians an automatic 10 bonus points, it is officially required for year 3, offering no bonus points. With the goal of focusing on performance-based scoring, Year 3 puts emphasis on individual measure scores.

Using a 2014 CEHRT will no longer be permitted in Year 3, leading to no scoring in categories such as Promoting Interoperability if used.

Fit Under Certain Criteria

Some eligible clinicians and groups qualify for low-volume threshold and can be exempt from participating in MIPS Year 3 altogether if they meet one of three criteria:

  • Provide care to less than 200 Medicare Part B Fee-for-Service (FFS) beneficiaries (updated)
  • Have billed $90,000 or less in Physician Fee Schedule (PFS) services to Medicare Part B FFS beneficiaries (updated)
  • Provide 200 or fewer covered professional services under the PFS

Embrace Patient Portals

Patient portals have helped not only clinicians connect with their patients, but improved patient satisfaction and helped clinical staff free up valuable time with less incoming calls.

Promoting Interoperability measures can easily be met through the use of patient portals. The integrated communication tools meet measures such as:

  • Secure messaging
  • Patient access
  • Patient-specific education

All in all, Year 3 of MIPS has expanded the scope of eligible clinicians, reweighed certain categories, and increased performance threshold points and penalties. Through value-based care, CMS aims to streamline the 2019 MIPS program to reduce overall costs and improve patient outcomes.