Medicare Compliance & Reimbursement

CMS cuts back on tech measures, but flexibility is lost in the process.

The last year of proposals and rules have rocked providers with an abundance of regulatory reform — some of it good, some of it bad. But, it looks like that was just the warm-up act as CMS rolls out more Quality Payment Program (QPP) shake ups, reductions, and rebalancing in 2019.

Background: On Nov. 1, CMS released a 2,378-page behemoth that combined several policy changes under the Medicare Physician Fee Schedule (MPFS) for CY 2019, including QPP Year 3 modifications. The final rule, slated for publication in the Federal Register on Nov. 23, maintains its laser focus on streamlining the Merit-Based Incentive Payment System (MIPS) and the higher-level Advanced Alternative Payment Models (APMs).

In the final rule, CMS outlined many tech-centric policy changes that specifically impact EHRs and the MIPS IT category, Promoting Interoperability (PI), which replaced Advancing Care Information (ACI) and Meaningful Use (MU) earlier this year.

“Today’s rule finalized changes to help make EHR tools that actually support efficient care instead of hindering care,” stated CMS Administrator Seema Verma about the QPP changes. “Final policies for Year 3 of the Quality Payment Program [QPP], part of the agency’s implementation of MACRA, will advance CMS’s Meaningful Measures initiative while reducing clinician burden, ensuring a focus on outcomes, and promoting interoperability.”

Take a Look at These QPP Year 3 Adjustments

Sometimes CMS policies look better on paper than in practice. This may be the case with MIPS PI updates that could make getting that Medicare pay increase challenging. “The biggest news in the final rule, in my opinion, is that CMS is moving forward with the MIPS PI scoring overhaul,” said Mike Schmidt, Vice President of Client Success and Regulatory Affairs for Eye Care Leaders in Charlotte, North Carolina. “This surprised me since I thought there would be a truly significant amount of public outcry against it.”

Schmidt warns, “Certainly it will make it significantly harder to get a perfect score for the MIPS PI performance category.” He adds, “While it does simplify the scoring by removing a number of measures (which is a welcome change), it eliminates the flexibility offered by MIPS ACI for 2017 and 2018, where participants could earn their performance or bonus points via different measures tailored to their specific practice situation.”

Here’s a short review of what’s ahead for Medicare providers in CY 2019:

• Prepare for MIPS revamps. No category (Cost, Quality, Improvement Activities, or PI) has been spared CMS tinkering. Some have been tweaked while others have been completely overhauled all in the name of reducing providers’ burden. Highlights include reweighting Quality and Cost, removing PI-type measures from Improvement Activities, mandating 2015 Edition CEHRT in Year 3 under PI, and revising measures and the scoring methodology for the tech component, to name a few.
• See MIPS-eligible clinician add-ins. Physical therapists, occupational therapists, qualified speech-language pathologists, qualified audiologists, clinical psychologists, and registered dietitians or nutrition professionals were added to the MIPS-eligible clinicians list for 2019.
• Review low-volume threshold finalizations for 2019. Now, MIPS clinicians or practices have three bars to meet to reach the low-volume threshold. Providers must have at least $90k in Part B allowed charges, administer care to at least 200 Part B beneficiaries, and provide at least 200 covered fee-schedule services.
• Know opt-in requirements. In 2019, it doesn’t matter if you aren’t exactly eligible, according to CMS. “Clinicians or groups will be able to opt-in to MIPS if they meet or exceed at least one, but not all, of the low-volume threshold criteria,” explains the QPP Year 3 overview.
• Help for small practices. CMS finalized a 6-point bonus for small practices and parked it in the Quality category rather than adding it to the composite score.
• Require more of Advanced APMs. Changes abound for Advanced APMs, including a mandate that 75 percent of Advanced APM providers upgrade to the latest editions of “CEHRT to document and communicate clinical care with patients and other health care professionals,” the QPP Year 3 fact sheet notes.
• Update facility-based scoring for MIPS providers. “CMS is providing the option for clinicians who are based at a healthcare facility to use facility-based scoring to reduce the burden of having to report separately from their facility,” said Verma.

Looking ahead: Medicare Compliance and Reimbursement will continue to dissect the MPFS CY 2019 final rule and other recent regulations released over the past few weeks. In a future issue, we’ll analyze and breakdown the revisions to the four MIPS categories and more.

Note: Review the MPFS CY 2019 at https://s3.amazonaws.com/public-inspection.federalregister.gov/2018-24170.pdf .