The rule finalized a few changes to the traditional MIPS categories, in keeping
with typical updates expected in annual rulemaking. The table below outlines the
most important changes in each category.
New HIE measure may boost PI performance, reduce reporting burden
The optional new HIE Bi-Directional Exchange measure is an alternative to the
two existing HIE send-and-receive/reconcile measures. Clinicians need not
submit performance data for the bi-directional measure. Reporting a “yes” earns
40 points. This could be an attractive option for clinicians who engage in bidirectional exchange through an HIE. See how it fits into existing PI
requirements on page 10 of the PDF or by downloading the 2021 MIPS PI measure guide.
1. TPCC: Total Per Capita Cost.
2. MSPB-C: Medicare Spending Per Beneficiary Clinician.
MIPS Performance Threshold
CMS did not make significant changes to its
overall scoring methodology for MIPS. But by
design, MIPS requirements are intended to
get harder each year.
The performance threshold (PT), or number
of points clinicians must achieve to avoid a
penalty, is set at 60 points for the 2021
performance year. This is an increase from
45 points in 2020. Exceptional performance,
or the points needed to qualify for additional
incentives, remains at 85 points.
Maximum MIPS incentives may remain low
MIPS is a budget-neutral program, where penalties collected are used to fund
positive adjustments. Generally, increasing the PT would mean more penalties.
However, due to Covid-19, CMS extended its Extreme and Uncontrollable
Circumstances policy to help impacted clinicians avoid penalties.
That means high-performing MIPS clinicians can expect positive adjustments to
remain low. It’s likely that only clinicians who achieve exceptional performance will
receive incentives, funded by an additional $500 million set aside by law to reward
the highest performers.