MIPS Category Weights

2018 VS. 2019

MIPS2018MIPS2019

Performance is measured through the data clinicians report in four areas - Quality, Improvement Activities, Promoting Interoperability (formerly Advancing Care Information), and Cost. MIPS was designed to update and consolidate previous programs, including: Medicare Electronic Health Records (EHR) Incentive Program for Eligible Clinicians, Physician Quality Reporting System (PQRS), and the Value-Based Payment Modifier (VBM).

The 2019 QPP Final Rule introduced Cost this year at 15%, so CMS is decreasing Quality’s weight to 45% to compensate. The PI and IA categories will remain at 25% and 15%, respectively.

To avoid 7% penalty in 2021, physicians need to score at least 30 MIPS points


Quality Measures

Category is Worth 45% of total MIPS score

Data Completeness:Submitted Quality measures must contain at least 60% of all Eligible Clinician patients across all payers.

Participants must submit data for at least 6 measures for the 12-month performance period (January 1 - December 31, 2019).

Participants should:

  • Submit collected data for at least 6 measures, or a complete specialty measure set; and

  • One of these measures should be an outcome measure; if you have no applicable outcome measure, you can submit a high priority measure instead

Quality measure bonus points can be earned in the following ways:

  • Submission of 2 or more outcome or high priority quality measures (bonus will not be awarded for the first outcome or high priority quality measure)

  • Submission using End-to-End Electronic Reporting, with quality data directly reported from an EHR to a qualified registry

  • View the list of Quality Measures:Explore Quality Measures

    Fact Sheet


Promoting Interoperability
(Formerly Advancing Care Information)

Category is Worth 25% of total MIPS score

CMS is re-naming the Advancing Care Information performance category to Promoting Interoperability (PI) to focus on patient engagement and the electronic exchange of health information using certified electronic health record technology (CEHRT). This performance category replaced the Medicare EHR Incentive Program for EPs, commonly known as Meaningful Use. This is done by proactively sharing information with other clinicians or the patient in a comprehensive manner. This may include: sharing test results, visit summaries, and therapeutic plans with the patient and other facilities to coordinate care.

  • For Performance Year 2019, 2015 Edition CEHRT is required for participation in this performance category.

  • Participants must submit collected data for certain measures from each of the 4 objectives measures (unless an exclusion is claimed) for 90 continuous days or more during 2019.

    Security is still a top priority:

    The Security Risk Analysis measure in the Protect Patient Health Information objective is still required but it is an unscored measure for every practice. EHR vendors are not responsible for making their products compliant with HIPAA Privacy and Security Rules. It is solely practice responsibility to have a complete risk analysis conducted.

  • Visit the list of PI(Advancing Care Information) measures: Explore PI(Advancing Care Information) Measures

    Fact Sheet

    Security Risk Analysis Tip Sheet


Improvement Activities

Category is Worth 15% of total MIPS score

This is a new performance category that includes an inventory of activities that assess how you improve your care processes, enhance patient engagement in care, and increase access to care. The inventory allows you choose the activities appropriate to your practice from categories such as, enhancing care coordination, patient and clinician shared decision-making, and expansion of practice access.  

To earn full credit in this category, participants must submit one of the following combinations of activities (each activity must be performed for 90 days or more during 2019):


COST

Category is Worth 15% of total MIPS score

This performance category replaces the VBM. The cost of the care you provide will be calculated by CMS based on your Medicare claims. MIPS uses cost measures to gauge the total cost of care during the year or during a hospital stay. Beginning in 2018, this performance category will count towards your MIPS final score.