2019 MIPS Quality Measures – What You Need To Know

Beth Hickerson, Healthcare Transformation Consultant Healthcare Consulting

At the end of each year, the Centers for Medicare & Medicaid Services (CMS) releases the final regulations for the Quality Payment Program for the following year. The regulations include updates to the approved quality measures. A clear and concise summary of the quality measure changes can be hard to find, so Medical Advantage has created quick reference guides for practices. 


These downloadable documents include four resources for 2019 MIPS Quality Measures:


1.       2019 MIPS Quality Measures - New Measures
These measures are available for reporting for the first time in 2019. Since these measures have not been reported before, CMS does not have historical data to use for benchmarking. A clinician or group reporting one of these measures will initially earn 3 points for the measure, assuming the data completeness criteria are met. If enough clinicians or groups report the measure for 2019, CMS may be able to create benchmarks based on performance year data. In that case, reporting clinicians or groups may earn more than 3 points, depending on their performance compared to others who report the measure. 


Medical Advantage’s MACRA Consultants recommend that practices report new measures as additional measures, rather than as one of their top six required measures, since scoring for new measures will be unpredictable. Also, keep in mind that since these measures are new, EHR vendors may not be able to build specifications quickly enough to make these measures available for 2019 reporting. 


2.       2019 MIPS Quality Measures - Deleted Measures

These are measures that CMS has removed from the MIPS reporting program. If a clinician or group reported any of these deleted measures in 2018 as one of their six required quality measures, they will need to choose a replacement measure for 2019.


3.       2019 MIPS Quality Measures - Topped Out Measures
These measures have an overall performance rate so high that meaningful distinctions and improvements in performance can no longer be made. CMS has a multi-year phase out cycle for topped out measures, which includes a 7-point cap for measures that have been classified as topped out for two or more consecutive years. A clinician who reports a topped-out measure with a 7-point cap will score no more than 7 points for that measure, even if they report a perfect 100% performance rate. Clinicians and groups are encouraged to report topped out measures with a 7-point cap only as additional measures above the required six measures, for maximum scoring potential. 


4.       2019 MIPS New Improvement Activities
Physicians must achieve a total of 40 points from improvement activities during a 90-day reporting period. CMS will score individual improvement activities as either high- or medium-weighted. High-weighted activities are worth 20 points, while medium-weighted activities are worth 10 points. Providers are required to perform four medium-weighted or two highweighted activities, or any combination of high- or medium-weighted activities for 2019. We have provided a list of improvement activities in our resource.


With MACRA constantly changing from year-to-year, it can be challenging for practices to keep up. Now is a great time to consider hiring consultants like Medical Advantage’s MACRA Ready Consultants. Our MACRA consultants have years of experience working as practice managers, nurses, and billing specialists. With our full-time focus and devotion to this program, we can offer insights to help your practice succeed in MACRA for 2019 and beyond. Get in touch today for a free consultation to find out how our services can support your practice!

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