Key Changes in 2019

The Centers for Medicare and Medicaid Services (CMS) updates the rules and requirements for the Quality Payment Program (QPP) annually. Many of the 2019 changes pertain to the Merit-based Incentive Payment System (MIPS) track.

  • You meet the criteria for a low-volume threshold exemption for the 2019 performance year if you:
    • care for 200 or fewer Medicare Part B patients, OR
    • submit $90,000 or less in Medicare Part B charges for covered professional services, OR
    • provide 200 or fewer Part B covered professional services.
  • Individuals or groups who meet or exceed all three of the above criteria are required to participate in MIPS. 
  • Those who meet or exceed one or two of the above criteria can choose to opt in to fully participate in the MIPS program. If a clinician or group chooses to opt in, they will be scored and receive a payment adjustment according to their performance during the 2019 performance year. 
  • Cost performance will be measured in 2019 and will contribute a larger amount to the overall final score.
  • There is a new scoring methodology for the Performing Interoperability performance category.
  • Quality performance will contribute a smaller amount to the overall final score.
  • Completion of the Safety Certification in Outpatient Practice Excellence for Women's Health (SCOPE) will count as the completion of one Improvement Activity beginning in 2019.
  • The performance threshold to avoid a negative payment adjustment increased from 15 points to 30 points.
  • Facility-based clinicians can use their hospital's performance under the Hospital Value-Based Purchasing (VBP) Program for their MIPS Quality and Cost performance categories.
  • Bonus points will be available for small practices, but the 6-point bonus score will be applied to the score for the Quality performance category, instead of the overall MIPS score.
  • Bonus points will be available for eligible clinicians and practices who care for complex patients.

In the Advanced Alternative Payment Model (A-APM) track, CMS implemented the All-Payer Combination Option. Starting in performance year 2019, ob-gyns and other health care providers may be able to qualify for the 5% bonus in this track by participating in Medicaid and commerical APMs in addition to Medicare models. 

For more information on these changes, visit our pages on the MIPS and A-APM tracks, or the QPP website.

Cost-Conscious Cases:

Physicians have a responsibility to our patients and society to “do no harm” which includes providing cost-conscious medical care.

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