CMS continues to propose modifications to the Quality Payment Program (QPP), which includes the Merit-Based Incentive Payment System (MIPS) program.
Key proposals for CY 2020 MIPS performance, which impacts 2022 payment:
- Increasing the MIPS performance threshold from 30 points in 2019 to 45 points in 2020 and proposing to set the threshold at 60 points in 2021.
- Increasing the exceptional performance threshold from 75 points in 2019 to 80 points in 2020 and 85 points in 2021.
- Revising category weights for Quality (decreases from 45% 2019 to 40% in 2020) and Cost (increases from 15% in 2019 to 20% in 2020).
- As a result of ASCRS advocacy, ophthalmology and optometry are removed from attribution of the Total per Capita Cost Measure (TPCC).
- Increasing the data completeness threshold for the quality data from 60% to 70% of Part B patients submitted via claims, and 60% of all patients to 70% of all patients using all other submission mechanisms.
In addition, following ASCRS and medical community advocacy to streamline the MIPS program, CMS is proposing a new participation pathway: MIPS Value Pathways (MVPs), beginning in the 2021 performance year. CMS is seeking to move toward an aligned set of measure options more relevant to a clinician’s scope of practice that is meaningful to patient care. The MVP framework would aim to align and connect measures and activities across the Quality, Cost, Promoting Interoperability, and Improvement Activities performance categories of MIPS for different specialties or conditions. CMS is seeking comment on this concept to begin in 2021 and has not formally proposed any pathways; however, CMS does use ophthalmology as an example, incorporating cataract surgery measures as well as general ophthalmology measures. ASCRS will be providing comment on this provision.
Despite ASCRS and ophthalmic community advocacy, CMS is proposing to eliminate the following quality measures:
- Measure 192, Cataracts: Complications within 30 Days Following Cataract Surgery Requiring Additional Surgical Procedures.
- Measure 388, Cataract Surgery with Intra-Operative Complications (Unplanned Rupture of Posterior Capsule Requiring Unplanned Vitrectomy).
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