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Use the updated MIPS participation lookup tool to check on your 2019 eligibility for the MACRA Quality Payment Program (QPP). To check your status, click on the link and enter your national provider identifier.

Exemptions for 2019

  • Obstetrician–gynecologists or their practices that submit $90,000 or less in Medicare Part B charges for covered professional services, see 200 or fewer Medicare patients annually, or provide 200 or fewer covered professional services under the Medicare Physician Fee Schedule are exempt from MIPS under the 2019 low-volume threshold.
  • Obstetrician–gynecologists who are new to Medicare and do not have a full year of claims history are also exempt.
  • Physicians who are qualifying participants in an advanced alternative payment model (APM) are exempt from MIPS.

Exemptions for 2018

  • Obstetrician–gynecologists or their practices that submit $90,000 or less in Medicare Part B charges or see 200 or fewer Medicare patients annually are exempt from MIPS under the 2018 low-volume threshold.
  • Obstetrician–gynecologists who are new to Medicare and do not have a full year of claims history are also exempt.
  • Physicians who are qualifying participants in an advanced APM are exempt from MIPS.

Payment incentives for higher performing physicians

  • The 2019 performance period started January 1, 2019, and will affect payment in 2021.
    • Nonexempt obstetrician–gynecologists who submit a full year of data on all four performance categories may be eligible for a positive payment adjustment of up to 7%.
    • Nonexempt obstetrician–gynecologists and other providers who do not submit data will be subject to a negative penalty of 7%.
  • Positive payment adjustments are subject to a scaling factor to achieve budget neutrality. Based on results from the first performance year, positive payment adjustments for the highest performing clinicians are likely to be lower than 7%.
  • The exceptional performance bonus is also subject to a scaling factor, which is not to exceed 1%.
  • There is no scaling factor for negative adjustments; cuts are capped at 7%.
  • Between 2019 and 2024 there will be $500 million in additional performance bonus dollars for exceptional performers, not subject to budget neutrality.
  • Obstetrician–gynecologists can choose to report as an individual or as a group.
  • You may also report on care delivered to nonMedicare patients, although the payment adjustments will only apply to your Part B payments.
  • You can also participate in MIPS through a MIPS APM.

Performance Categories

Quality

This category will account for 45% of a physician’s MIPS score during the 2019 performance year, down slightly from 50% in 2018.

In performance year 2019, you should report on six quality measures for the full year.

You’ll choose one outcomes measure if available or another high-priority quality measure. High-priority quality measures relate to patient outcomes, appropriate use, patient safety, efficiency, patient experience, or care coordination. Groups with 25 clinicians or more must report on all 15 quality measures.

Visit the QPP website to view the list of available quality measures and filter by specialty to see a list of appropriate measures for obstetrician–gynecologists.

Promoting Interoperability (Previously Advancing Care Information)

This category will account for 25% of your total MIPS score in 2019, the same as in 2018.

Beginning in 2019, CMS is implementing a new scoring methodology for the Promoting Interoperability performance category. This new methodology is individual measure-based and the points received for each measure add together to total the score for this category. In 2019, nonexempt clinicians will be required to use 2015 Certified Electronic Health Record Technology to report to MIPS.

Objectives Measures Maximum Points
e-Prescribing e-Prescribing 10 points
Bonus: Query of Prescription Drug Monitoring Program 5 bonus points
Bonus: Verify opioid treatment agreement 5 bonus points
Health Information Exchange Support electronic referral loops by sending health information 20 points
Support electronic referral loops by receiving and incorporating health information  20 points
Provider to Patient Exchange Provide patients electronic access to their health information 40 points
Public Health and Clinical Data Exchange Report to two different public health agencies or clinical data registries for any of the following: immunization registry reporting, electronic case reporting, public health registry reporting, clinical data registry reporting, syndromic surveillance reporting 10 points

Physicians are also required to complete the Security Risk Analysis measure, which does not have any points assigned to it.

Visit the QPP website for more information on this new scoring methodology, new measure exclusions, or to see how this category was scored in previous performance years.

Improvement Activities

The improvement activities category accounts for 15% of the MIPS score 2019, the same as in 2018.

Physicians will be rewarded for implementing improvement activities that focus on care coordination, beneficiary engagement, and patient safety. You’ll have more than 90 options from which to choose under the following categories:

  • Expanded practice access
  • Beneficiary engagement
  • Achieving health equity
  • Population management
  • Patient safety and practice assessment
  • Emergency preparedness and response
  • Care coordination
  • Participation in an APM, including a medical home model
  • Integrated behavioral and mental health

Visit QPP website for the full list of improvement activities and their associated weights.

To earn full credit in this category, physicians will need to report doing two high-weighted activities, four medium-weighted activities, or one high-weighted activity and two medium-weighted activities.

Individuals or groups who practice in a small practice of 15 or fewer clinicians, rural practices, a health professional shortage area, or in a nonpatient-facing practice will receive double points for all completed improvement activities.

Beginning in 2019, obstetrician–gynecologists can receive credit for one medium-weight activity if they complete the Safety Certification in Outpatient Practice Excellence for Women's Health and receive Maintenance of Certification Part IV credit for completion.

You can also receive credit in this category for participating in APMs and patient-centered medical homes. Physicians participating in an accredited patient-centered medical homes will get full credit under this category and do not have to report on any other activities.

Cost

This category will count towards 15% of your total MIPS score in 2019, up from 10% in 2018.

Your score will be automatically calculated based on your Medicare claims; you will not have any reporting or other requirements to receive your score.

CMS will calculate scores for total per capita cost and Medicare spending per beneficiary, and provide feedback to obstetrician–gynecologists and other providers based on performance in 2019 and beyond. Visit the QPP website for more information on these cost measures. CMS also adopted several episode-based cost measures for the 2019 performance year, but none of them apply to obstetrician–gynecologists at this point.

Facility Based Scoring

Beginning in 2019, facility-based clinicians can apply their hospital value-based purchasing program score to their scores for the MIPS cost and quality categories. CMS defines facility-based individual clinicians as those who furnish 75% or more of their covered professional services in inpatient hospital, on-campus outpatient hospital, or emergency room locations. Facility-based groups are those in which at least 75% of the MIPS eligible clinicians billing under the group's tax identification number are eligible for facility-based measurement as individuals. CMS will automatically apply the higher score to participants' cost and quality categories, whether it is the value-based purchasing score or data submitted by the participants themselves.

MIPS APMs

Obstetrician–gynecologists and groups that participate in an APM but are not eligible to be qualifying participants in an advanced APM may choose to participate in MIPS through a MIPS APM. Some Medicare APMs do not qualify as advanced APMs under the QPP but do qualify as MIPS APMs. Some physicians and groups participate in APMs that do qualify as advanced APMs but do not meet or exceed the payment and patient thresholds required for participation. For performance year 2019, APM entities must receive at least 50% of their payments through the APM or see at least 35% of their patients through the APM to qualify as an advanced APM. Those who don't meet these thresholds should consider reporting to MIPS as a MIPS APM.

Participants in MIPS APMs receive special scoring under the APM scoring standard. For the quality performance category, MIPS APMs are only scored on those measures that are required for their specific APM.

MIPS APMs are subject to the same low-volume threshold criteria, but these criteria are applied at the APM entity level. The performance period for MIPS APMs is also the regular 12-month MIPS performance period.

MIPS APMs are alternative payment models that meet the following criteria:

  • APM entities that participate in the APM under an agreement with CMS
  • Have one or more MIPS eligible clinician on the participation list for the APM
  • APM bases payment on quality measures and cost and utilization (either at the APM entity or individual provider level)

The following models are eligible to be MIPS APMs in the 2019 performance year:

  • Bundled Payments for Care Improvement Advanced Mode
  • Comprehensive ESRD Care: one-sided and two-sided risk
  • Comprehensive Primary Care Plus Model
  • Independence at Home Demonstration
  • Medicare Shared Savings Program (all tracks)
  • Medicare Accountable Care Organization, Track 1+ Model
  • Maryland Total Cost of Care Model
  • Oncology Care Model (all tracks)
  • Vermont All-Payer ACO Model