MIPS will be the pathway for a majority of Orthopaedic Surgeons to participate in QPP. MIPS combines CMS's three existing reporting programs - Physician Quality Reporting System (PQRS), Value-based Modifier, and EHR Meaningful Use, under a single entity.
2019 MIPS Metrics
To calculate your MIPS score, CMS will evaluate your performance in four categories. Scores in each area will be weighted. CMS will adjust the weights for each category each program year.
- Quality - 45%
- Must submit data for at least 6 measures (or a complete specialty measure set) while one of these measures should be an outcome measure (if you have no applicable outcome measure, may submit another high priority measure instead)
- For groups of 16 or more clinicians who meet the case minimum of 200, the administrative claims-based all-cause readmission measure will be automatically scored as a seventh measure
- Data completeness requirements for Year 3
- Claims: 60% of Medicare Part B patients for the performance period.
- QCDR/Registry/EHR: 60% of clinician's or group's patients across all payers for the performance period.
- In Year 3, individual eligible clinicians can submit measures via multiple collection types (MIPS CQM, eCQM, QCDR measures, and for small practices, Medicare Part B claims measures).
- The small practice bonus will now be added to the Quality performance category, rather than in the MIPS final score calculation. 6 bonus points are added to the numerator of the Quality performance category for MIPS eligible clinicians in small practices who submit data on at least 1 quality measure.
- Promoting Interoperability (replaces ACI) - 25%
- Year 3 completely revamps the PI scoring methodology by eliminating the base, performance, and bonus scores; provides for performance-based scoring at the individual measure-level. Each measure will be scored based on the MIPS eligible clinician's performance for that measure based on the submission of a numerator or denominator, or a “yes or no” submission, where applicable.
- Finalized the Security Risk Analysis measure as a required measure without points.
- The scores for each of the individual measures will be added together to calculate the score of up to 100 possible points. If exclusions are claimed, the points for measures will be reallocated to other measures.
- Eligible clinicians must use 2015 Edition CEHRT in Year 3.
- Clinical Improvement Activities (CPIA) - 15%
- Category that focuses on care coordination, beneficiary engagement, and patient safety
- Modifications include the addition of one new criterion in this category, “Include a public health emergency as determined by the Secretary,” and the removal of, “Activities that may be considered for a Promoting Interoperability bonus.”
- List of orthopaedic-related improvement activities - In development
- Cost - 15%
- No reporting will be required for this category. CMS will calculate your score based on claims data in 2019 and report it to you via feedback report
- CMS added 8 new episode-based measures to the Cost performance category, including the Knee Arthroplasty measure which AAOS helped develop as part of the Musculoskeletal Clinical Subcommittee.
- Cost performance category percent score will not take into account improvement until the 2024 MIPS payment year.
For scoring Facility-Based Quality and Cost Performance Categories, the measure set for the fiscal year Hospital Value-Based Purchasing (VBP) program that begins during the applicable MIPS performance period will be used for facility-based clinicians (FY 2020 for 2019 performance period).
Scoring: A single MIPS composite performance score will factor in performance in the four weighted categories. Orthopaedic Surgeons can receive positive or negative payment adjustments based on their composite performance score. There will be "winners" and "losers".
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