After proposing otherwise, CMS has decided to assign the same weights to the four MIPS performance categories as it did in 2019:
- Quality – 45 percent
- Improvement Activities – 15 percent
- Promoting Interoperability – 25 percent
- Cost – 15 percent
By statute, Cost must be increased to 30 percent and Quality must be reduced to 30 percent by 2022.
In 2020, the minimum performance score required to avoid any MIPS penalty will increase from 30 to 45 points. In 2021, it will increase to 60 points. The threshold to qualify for the exceptional performance payment will increase from 75 to 85 points in 2020 and 2021. Finally, the maximum incentive payment and penalty will increase to 9 percent in 2020.
In 2020, there will be 20 measures in the Cost category: the Medicare Spending Per Beneficiary measure, the Total Per Capita Cost measure, and eighteen episode-based measures. CMS is adding 10 new episode based measures, including a new measure for lumpectomy, partial mastectomy and simple mastectomy.
In the Final Rule, CMS discussed at length its intent to expand the number of episode-based measures in future years to include more specialties, including the process for developing and validating those measures.
CMS will calculate a Cost score based on a combination of all the Cost measures for which a physician or group qualifies. However, CMS will not calculate a score in the Cost category if the physician or group does not meet the case minimum for at least one of the measures. In those cases, the 15 percent Cost category weight will be transferred to the Quality category, raising the percentage from 45 percent to 60 percent.