How is MIPS changing in 2020

The Centers for Medicare & Medicaid Services (CMS) announced changes to the Merit-based Incentive Payment System (MIPS) on July 29, 2019, that are intended to streamline the Quality Payment Program (QPP). CMS is focused on reducing administrative burden for healthcare providers with its new pay-for-performance program called the MIPS Value Pathways (MVP). In the same announcement, CMS included updates to the Medicare Physician Fee Schedule (PFS) effective January 1, 2020.

One of the goals of the updated policies is to help physicians who care for chronically ill patients. CMS Administrator Seema Verma states that “Today one in five Medicare beneficiaries have multiple chronic diseases.” The proposed rule for 2020 “would increase payments to practitioners for time spent on care management after a patient leaves the hospital ensuring proper follow-up and continuity of care for patients.” In addition, CMS is proposing, for the first time, “to pay for care management services for patients with a single, high-risk chronic condition such as diabetes or high blood pressure.” Under the new rule, physicians would also be paid for “additional time spent on care management activities for patients suffering from multiple chronic conditions.”

The new MVP program would begin in the 2021 performance period, moving MIPS “from its current state, which requires clinicians to report on many measures across the multiple performance categories, such as Quality, Cost, Promoting Interoperability and Improvement Activities, to a system in which clinicians will report much less. Under MVPs, clinicians would report on a smaller set of measures that are specialty-specific, outcome-based, and more closely aligned to Alternative Payment Models (APMs) – new approaches to paying for care through Medicare that incentivize quality and value.”

CMS’s proposed rule includes:

• CY 2020 PFS rate setting and conversion factor
• Medicare telehealth services
• Payment for evaluation and management services
• Physician supervision requirements for physician assistants
• Review and verification of medical record documentation
• Care management services
• Comment solicitation on opportunities for bundled payments
• Medicare coverage for opioid use disorder treatment services furnished by opioid treatment programs
• Bundled payments for substance use disorders
• Therapy services
• Ambulance services
• Ground ambulance data collection system
• Open Payments Program
• Medicare Shared Savings Program
• Stark advisory opinion process

The public is invited to comment on the CY 2020 Physician Fee Schedule proposed rule and the CY 2020 Quality Payment Program proposed rule. Comments must be received within the 60-day comment period, which closes on September 27, 2019. When commenting refer to file code: CMS-1715-P.