• Quality: 65 percent
• Cost: 20 percent
• Improvement activities: 15 percent

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Explore This Issue

ACEP Now: Vol 38 – No 10 – October 2019

Figure 1: 2020 MIPS Category Weighting for Typical ED Providers

In the proposed rules, CMS also advances some significant changes to MIPS, including:

MIPS Performance Thresholds Increasing, Making It Harder to Avoid a Penalty

• CMS proposes to increase the MIPS performance threshold, which is the minimum number of points needed to avoid a negative payment adjustment, from 30 points in 2019 to 45 points in 2020 and 60 points in 2021 (see Figures 2 and 3).
• CMS also proposes to increase the exceptional performance threshold (which allows for extra bonus dollars) from 75 points in 2019 to 80 points in 2020 and 85 points in 2021.
• CMS proposes to increase the quality measure data completeness reporting requirement from 60 percent to 70 percent of applicable patients.

Quality Category Goes Down, Cost Goes Up

• CMS proposes to reduce the weight of the quality category for general medical providers from 50 percent to 40 percent in 2020, 35 percent in 2021, and 30 percent in 2022 while correspondingly increasing the weight and impact of the cost category.
• For each individual quality measure, a provider’s raw percentage of meeting the measure’s requirements is benchmarked against the universe of providers reporting that measure to yield a decile score. Each decile is then converted to a MIPS quality point score on a scale of 1–10. Your “quality points” are then added to your total MIPS score based on the weighting of the quality category for your reporting entity.

The cost category is calculated based on 10 measures:

• Total per capita costs for all attributed beneficiaries measure
• Medicare spending per beneficiary measure
• Elective outpatient percutaneous coronary intervention
• Knee arthroplasty
• Revascularization for lower extremity chronic critical limb ischemia
• Routine cataract removal with intraocular lens implantation
• Screening/surveillance colonoscopy
• Intracranial hemorrhage or cerebral infarction
• Simple pneumonia with hospitalization
• ST-elevation myocardial infarction with percutaneous coronary intervention

CMS Proposes Multiple Changes to Emergency Medicine–Focused Quality Measures

• To remove the following measures from the emergency medicine specialty set, meaning that CMS no longer views these as relevant to emergency physicians: #91: acute otitis externa: topical therapy; and #255: Rh immunoglobulin (Rhogam) for Rh-negative pregnant women at risk of fetal blood exposure.
• To remove the claims-based version of measure #415: emergency department utilization of CT for minor blunt head trauma for patients aged 18 years and older from MIPS due to topped-out status but to maintain the measure for registry reporting.
• To remove emergency department patients from inclusion in measure #326: atrial fibrillation and atrial flutter: chronic anticoagulation therapy.

CEDR Can Help

The penalty for not meeting MIPS requirements in 2020 will be 9 percent for typical ED groups. ACEP Clinical Emergency Data Registry (CEDR) is available as an EM-specific reporting mechanism to take care of your MIPS reporting requirements. Learn more.