7 key changes to the QPP in CMS' final physician payment rule

CMS issued a final rule Nov. 1 for the physician fee schedule in 2019, which includes updates to the Quality Payment Program.

Here are seven things to know about the QPP updates, which affect the 2019 performance year or 2021 payment year:

1. CMS expanded eligibility for the Merit-based Incentive Payment System to include physical therapists, occupational therapists, qualified speech-language pathologists, qualified audiologists, clinical psychologists, and registered dieticians or nutrition professionals.

2. The low-volume threshold, which excludes physicians from MIPS if they bill less than $90,000 in Medicare Part B charges per year or provide care for 200 or fewer Medicare Part B enrollees, now includes a third criterion. In 2019, physicians can also be excluded from MIPS if they provide 200 or fewer covered professional services under the physician fee schedule. Physicians only have to meet one of the three criteria to be excluded from the program.

3. However, in 2019, clinicians have the option to opt in to MIPS if they meet or exceed at least one of the low-volume threshold criteria. They do not have to meet or exceed all three criteria to opt in.

4. CMS updated the weights of the four performance categories as follows:

  • Quality was updated to 45 percent from 50 percent.
  • Cost was updated to 15 percent from 10 percent.
  • Improvement activities was kept at 15 percent of the final score.
  • Promoting interoperability remains weighted at 25 percent.

5. Payment adjustments can now range from +/- 7 percent, a greater range than the year prior, when adjustments were set to +/- 5 percent. Some physicians could see a greater than 7 percent positive payment adjustment, as it is multiplied by a scaling factor, but CMS said it will generally be up to 7 percent.

6. CMS increased the certified EHR technology use threshold for Advanced Alternative Payment Models to require at least 75 percent of eligible clinicians using CEHRT to document care, up from 50 percent the year prior.

7. CMS is expanding its options to apply as all-payer APMs in several ways, including creating a process for payers and providers to share their contract length with CMS so if they are determined an Advanced APM, they will remain an Advanced APM for the duration of the contract up to five years.

Find the full list of changes here.  

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