Changes in the MIPS 2019 Proposed Rule: Quality Category

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The Centers for Medicare & Medicaid Services (CMS) recently issued its Proposed Rule for 2019 under the Quality Payment Program. In this week’s blog we examine changes in the Quality performance measure category.
CMS will apply the general rules as the agency has done before in the proposed Quality category. Practices or providers will report six measures with one being an outcome measure. The category continues to be 45 percent of the final score and data completeness is at 60 percent. Eligible clinicians and groups can report Quality measures across multiple collection types, including registry, EHRs and claims.
One of their most significant proposed changes is to the measures that can be selected for reporting. CMS plans to implement 10 new measures, but also to eliminate 33 other measures. Some practices may currently be using those measures in reporting, so CMS encouraged practices to review both sets of measures—those new and those scheduled for removal. The change in measures may impact some practices, especially those measuring Hypertension: Improvement in Blood Pressure or performing a Functional Status Assessment for Total Knee Replacement, as two examples of measures being removed.
CMS also has proposed to create new terms around Collection Type (eCQMs in place of EHR reporting), Submitter Type and Submission Type (Direct submission indicating computer to computer instead of EHR reporting). 
As part of the focus on prescription drug abuse, high-priority measures will now encompass opioid-related
In 2019, small practices (15 or fewer eligible clinicians) will automatically receive three bonus points in the Quality category. Bonus point caps will continue, using 10 percent of the total possible points for high-priority bonus points and CEHRT bonus points.
CMS is also considering measure reweighting. If clinical guidelines greatly impact a measure during the performance year, CMS would reweight the measure to zero to protect patient safety; and if your practice opted to report CAHPS but did not have enough beneficiaries to meet the case minimum, CMS will reweight the measure to zero.
The comment period for the 2019 Proposed Rule closed in September. We expect the Final Rule on the proposals above to be released in November.
If you have additional questions about the 2019 Proposed Rule or questions about MIPS reporting, contact the Quality Reporting Engagement Group at
This information was taken from the InfoDive Coding and Audits webinar held in November 2018.