2020 QPP – Goals and Takeaways

Are you planning on, or required to, participate in the Quality Payment Program (QPP) in 2020? If you are, it is imperative that you are aware of all of the changes that have been made for this reporting year. The ONC’s Final Rule proposed a number of changes that will affect your practice as of January 1, 2020. The following takeaways and goals of the 2020 QPP will inevitably affect the reimbursement your practice receives.

General Takeaways of 2020 QPP:

• Positive & Negative Payment Adjustment: The positive and negative payment adjustment threshold has increased to +/-9% for this reporting year which is an increase of +/-2% over the last reporting year.
• Performance Threshold Increase: The performance threshold is the amount of MIPS points needed for an Eligible Clinician (EC) to avoid penalties. This has increased this reporting year. This year, 45 MIPS points must be obtained which has increased from 30 in 2019.
• Exceptional Performance Threshold Increase: In order to achieve a bonus, 85 MIPS points must be achieved which is a 10 point increase over last year.
• Category Weights: The weights for Quality, Cost, Promoting Interoperability, and Improvement Activities have remained the same. (Note: These are slated to change in next year’s Final Rule.)

Quality Category Takeaways:

• 70% data completeness must be achieved for eligible cases in order to receive points in 2020. Practices that meet small practice criteria would be eligible to receive 3 points despite not meeting data completeness requirements.
• Topped out measures in the quality category have been removed.
• The following new specialty sets have been added: speech language pathology, audiology, endocrinology, chiropractic medicine, pulmonology, nutrition/dietician, and clinical social work.

Promoting Interoperability Takeaways:

• Clinicians can satisfy the Query of Prescription Drug Monitoring Program (PDMP) with yes/no answer.
• CMS removed the Verify Opioid Treatment Agreement
• No other major changes have been made to this category.

Improvement Activities Takeaways:

• The participation threshold has increased to 50% for clinicians reporting as a group in this category.
• The definition for rural area is being redefined based on zip code designated as rural by the Federal Office of Rural Health Policy (FORHP).
• CMS removed criteria stating that a Patient-Centered Medical Home must be accredited by 4 national accreditation organizations.

Cost Takeaways:

• No changes have been made to the minimum requirements in this category.
• 10 new episode-based measures have been added to this category and current measures are being revised.

Goals of QPP:

To put it simply, incentive programs like QPP, MIPS, and MACRA, were all developed to help drive better health outcomes for patients. It promotes quality and cost efficient care across the healthcare sphere and couples it with the promise of reimbursement if certain measure sets are hit or exceeded. As these programs have grown and expanded, they have also began to promote the use of healthcare technology as a way to increase interoperability and continuity of care. As ECs work diligently to ensure they receive a positive payment adjustment, patients reap the benefits with quality and cost effective care across their care team.

Are you looking for a new EHR solution to enable your practice to meet QPP standards? Visit us at micromd.com or call us at 800-624-8832.