MACRA Minute – August 2019

New: QPP Participation Stats from CMS

CMS recently released QPP participation statistics for 2018. Highlights from the 2018 Participation Infographic include:

  • 98 percent of MIPS ECs participated 
  • 89 percent of MIPS ECs in small practices participated
  • 98 percent of ECs scored above the performance threshold

Participation rates increased from 95 percent in 2017. Clinicians in small practices increased from 81 percent in 2017 to nearly 90 percent in 2018. 
Keep up the good work!


New: CMS Releases 2020 QPP Proposed Rule 

In late July, CMS released proposed policies for the QPP 2020 performance year.

Key 2020 Proposals Include:

  • Increasing the performance threshold to 45 points (from 30 points)
  • Decreasing the Quality category weight to 40 percent (from 45 percent)
  • Increasing the Cost category weight to 20 percent (from 15 percent)
  • Increasing the completeness threshold for quality data submitted
  • Increasing the threshold for groups reporting an Improvement Activity 
  • Revising specifications for the Total Per Capita Cost & Medicare Spending Per Beneficiary Clinician Cost Measures
  • Updating requirements for Qualified Clinical Data Registry measures, including the services third-party intermediaries must provide (beginning performance period 2021)

The Future of MIPS: CMS is committed to the ongoing transformation of MIPS, including: 

  • More streamlined & cohesive reporting
  • Enhanced & timely feedback loops
  • Pathways of integrated measures that are meaningful to clinicians & patients
  • Introducing the new MIPS Value Pathways to encourage the transition to APMs & promote value 

MIPS Value Pathways:
MVPs create of “bundles” or “tracks” of care that connect measures & activities across the four performance categories. Our hope is that MVPs will be available for all clinicians and co-developed in partnership with specialty societies or other organizations. 

The proposed MVP includes:

  • Incorporating a foundation for leveraging Promoting Interoperability measures 
  • Administrative, claims-based quality measures with population & public health priorities that are meaningful to clinicians
  • Potential MVPs include Major Surgery & Diabetes Prevention & Treatment
  • ECs would participate in one MVP that aligns measures & activities across the four performance categories 

Submit Your Comments: CMS is seeking comment on a variety of proposals, including the MVPs. They’re seeking feedback on how to further transform MIPS to reduce burden, increase value, and focus participation around health priorities that are meaningful to practices and specialties. 

Comments are due by September 27, 2019 & can be submitted electronically to Regulations.gov or via regular, express, or overnight mail.

Learn More:
See the following CMS resources for more information: 


Reminder: QPP Performance on Physician Compare

In July 2017, QPP performance information became available on the Physician Compare website. The site’s star ratings demonstrate how well ECs/groups provide care against top performers for each measure. Measures are divided into the following categories: 

  • General Health
  • Cancer Screening
  • Patient Safety
  • Care Planning
  • Diabetes
  • Heart Disease
  • Respiratory Diseases
  • Behavioral Health

Patient survey scores from CAHPS are also posted to the site.


Deadline: Submit Target Reviews 

Targeted review submissions are due September 30, before 7 p.m. CST. If, after reviewing your final feedback, you believe an error was made in your 2020 payment calculation, you may request a Targeted Review. The following are examples of circumstances warranting a targeted review: 

  • Errors or data quality issues for the measures & activities you submitted
  • Eligibility & special status issues (e.g., you fall below the low-volume threshold & didn’t qualify for a payment adjustment)
  • Being erroneously excluded from the APM participation list & scoring standard
  • Performance categories not automatically reweighted due to extreme and uncontrollable circumstances

The request form can be found on the performance feedback page of the QPP Portal. After completing the review, you will receive a confirmation email or request for further documentation. 
Once your review has been evaluated, you will receive an email that either approves or denies your request. Decisions are final & no further review will be available once the decision is made. 

For More Information: If you need assistance with a Targeted Review, please reach out to your Telligen SURS team at 1-844-358-4021 or the QPP Help Desk at 1-866-288-8292. Additional information is available in the following CMS materials: 

2018 Targeted Review Fact Sheet

2018 Targeted Review FAQs


Save the Date: Upcoming Webinars

CMS August LAN Webinar: Maximizing your Quality Score. This upcoming event will focus on techniques and advice for maximizing your quality score, including using claims, EHRs and registries to submit your quality data.

Tuesday, August 20 from 2:30 to 3:30 p.m. CT or 

Thursday, August 22 from 10:00 to 11:00 a.m. CT

Note: The Telligen July webinar, “Reviewing 2018 MIPS performance Feedback Reports & Targeted Reviews, was rescheduled due to technical difficulties. We apologize for the inconvenience. A recording & slides are now available for reference.


Reminder: Data Validation Audits

CMS has contracted with Guidehouse to audit a select number of ECs in order to ensure MIPS operates with accurate & useful data. ECs, groups, and virtual groups are required to comply & provide all data as requested by CMS. 

Audits, occurring from July to September 2019, will cover data submitted for the 2017 and 2018 performance periods. Selected ECs will receive a request for information from Guidehouse sent via email or certified mail.  Following the request, ECs will have 45 calendar days to provide information. 

If you are selected, the Telligen team is here to help. Please contact us at 1-844-358-4021 or qpp-surs@telligen.com if you have any questions or need assistance.


Resources: New to the QPP Library

The following resources were updated or added to the QPP Resource Library in July:

This material was prepared by Telligen QPP-SURS Resource Center, the Quality Payment Program for Iowa, Nebraska, North Dakota and South Dakota, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. HHSM-500-2017-00012C.

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