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MIPS Performance Categories

Quality Performance Category

To meet this requirement, most emergency physicians will have to report on six measures over a 12-month period. The Quality category will count for 45 percent of your total score in 2019. One great way to meet the Quality requirement is by reporting through a qualified clinical data registry (QCDR). ACEP has developed its own QCDR, called the Clinical Emergency Data Registry (CEDR).  Starting in 2019, another option for meeting the Quality category called the “facility-based scoring option” will be available to emergency physicians. See below for more details.

Find out more about CEDR

Cost Performance Category

Cost is automatically calculated by CMS based on two major measures: the Medicare Spending Per Beneficiary (MSPB) measure and the Total Per Capita Cost measure. Cost will represent 15 percent of your total score in 2019. If these measures do not apply to you or your practice, you will not receive a cost score and your quality score will count for 60 percent of your total score. Starting in 2019, another option for meeting the Cost category called the “facility-based scoring option” will be available to emergency physicians. See below for more details.

Improvement Activities Performance Category

This category rewards participation in activities that improve clinical practice. There is a list of activities that are classified as either medium or high-weighted based on their value to patient care. 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):

  • 2 high-weighted activities
  • 1 high-weighted activity and 2 medium-weighted activities
  • 4 or more medium-weighted activities

For more details see the CMS improvement activities list, located under Improvement Activities.

Another great way to meet the requirements of this performance category is by participating in ACEP’s Emergency Quality Network (E-QUAL) Initiative.

Promoting Interoperability Performance Category

This category includes measures and objectives related to the use of electronic health records (EHRs). Most emergency physicians are exempt from this category (formally known as the “Meaningful Use” program) because they are “hospital-based” clinicians who use their hospital’s EHR. However, if you report as part of a group, you might not be exempt.

ACEP has created an action alert to help you understand your options if you are not classified as “hospital-based.” Please review these documents immediately, as there is a deadline of December 31, 2018 to apply for a category exemption if you are not determined to be “hospital-based.”

What’s new in 2019?

One new scoring option available to emergency physicians starting in 2019 is called the facility-based scoring option for the Quality and Cost categories of MIPS.

With this new scoring option, clinicians who deliver 75 percent or more of their Medicare Part B services in an inpatient hospital, on-campus outpatient hospital, or emergency room setting will automatically receive the quality and cost performance score for their hospital through the Hospital Value-based Purchasing (HVBP) Program starting in 2019. CMS estimates that most emergency physicians would qualify for this option. Clinicians who qualify for the option can still report quality measures through another submission mechanism (such as a QCDR) and receive a “traditional” MIPS score for quality. If they do so, CMS will automatically take the highest of the HVBP score and the traditional MIPS score.

CMS plans to make information about the facility-based scoring option available to clinicians during the first quarter of 2019. At that time, you will be able to find out whether or not you are eligible for this option and what your possible HVPB score will be. That way, you can make an informed decision about how to participate in MIPS.

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