By Kim Hathaway, MSN, CPHRM, Healthcare Quality Patient Safety and Risk Consultant, The Doctors Company

This marks the third year of the QPP, which was established in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
Highlights of the changes made to MIPS for 2019 include:

1. Category weights have changed for two categories. The category changes include:
   • Quality: 45 percent (down from 50 percent in 2018).
   • Cost: 15 percent (a 5 percent increase from 2018).
2. Important general MIPS changes for performance year 2019 include:
   • The performance period for the third year of the QPP/MACRA is the calendar year 2019. Performance for 2019 will affect payment in 2021.
   • The performance threshold increases in 2019 from 15 MIPS points to 30 MIPS points
   • The exceptional performance bonus increased to 75 points (up from 70 points in 2018).
   • The total amount of Medicare reimbursement at play for 2019/2021 has increased.
   • The five bonus points added to the final score of clinicians in small practices (TINs with fewer than 15 associated NPIs) increases to six points.
   • Eligibility has been adjusted to allow more clinician participation in MIPS, even by providers excluded based on the low-volume threshold criteria.
   • Eligible clinician types have expanded
3. The MIPS Quality category has:
   • Separated collection types from submission types.
   • Added eight and removed 26 measures.
   • Made claims-based measures available only to groups with fewer than 15 physicians.
4. MIPS Advancing Care Information category changed in 2018 to Promoting Interoperability.
   The Promoting Interoperability changes for 2019 include:
   • Four aims clinicians must meet: e-Prescribing, Health Information Exchange, Provider to Patient Exchange, and Public Health and Clinical Data Exchange.
   • Any unreported measure or no answers to a yes/no measure will result in a zero Promoting Interoperability score.
   • MIPS-eligible clinicians are requiredto use the 2015 Edition of Certified Electronic Health Record Technology (CEHRT) if they report in this category and must submit evidence to CMS.
   • The Promoting Interoperability reporting period will remain a minimum of a continuous 90-day period.
   • Scoring is now solely based on performance and the base.
   • Security risk analysis is still required, but no points will be assigned.
   • Two new measures are added for the e-Prescribing objective.
5. MIPS Improvement Activities category changes include:
   • Removal of the 10 percent Promoting Interoperability bonus for using a CEHRT to complete the Improvement Activity.
   • Clarification of the criteria for "high-weighted" classification.
6. MIPS Cost category changes include:
   • Eight episode-based Cost measures have been added. The same two core measures for Medicare Spending per Beneficiary and Total Per Capita Cost remain.
   • All cost measures have the same weight.
7. Alternative Payment Models: More specialty-related models will be developed.

Practices that find these changes overwhelming may want to reach out for expert help with industry-leading best practices to maximize Medicare payments. Visit Medical Advantage Group  (medicaladvantagegroup.com) for more information. For resources on MACRA and success in optimizing reimbursement, go to MACRA Resources for Medical Practices (thedoctors.com/MACRA).