Key MACRA changes highlighted

CMS has limited the changes for 2021 MIPS reporting due to the COVID-19 crisis

The Medicare Access and CHIP Reauthorization Act (MACRA) is in its fifth calendar year, and the Centers for Medicare & Medicaid Services (CMS) continues to publish rule changes annually.

CMS has limited the changes for 2021 Merit-based Incentive Payment System (MIPS) reporting due to the COVID-19 crisis.

The agency also introduced the Alternative Payment Model (APM) Performance Pathway (APP) for 2021 to reduce the burden on clinicians and stakeholders.

Key changes in the relative weight of the four MIPS performance categories—quality, cost, promoting interoperability (PI) and improvement activities (IA)—were made.

These include cost increases from 15 to 20% of the final score and quality decreases from 45 to 40%. The minimum reporting threshold to avoid penalties increases from 45 to 60 points, while the threshold for the exceptional performance category remains at 85 points.

Clinicians not participating at this level in 2021 will experience up to a 9% penalty in their 2023 Medicare reimbursements.

For MIPS APMs reporting traditional MIPS measures, the performance weightings are: quality, 50%; cost, 0%; PI, 30%; and IA, 20%—again with a minimum threshold of 60 points. Eleven quality measures were removed for 2021, including “All-Cause Hospital Readmission.” Changes to more than 100 existing measures and the addition of two new administrative claims measures were implemented.

Importantly, the PI category retained the “Query of Prescription Drug Monitoring Program,” which is worth 10 points, or one-sixth of the points needed to avoid a penalty. In the IA category, CMS will continue to give credit for COVID-19-related data reporting, but only if entered into a clinical data registry.

Additional COVID-19-specific changes doubled the number of points available for the complex patient bonus—up to 10 points for the 2021 performance year. Clinicians with practices affected by COVID-19 can petition for re-weighting of the performance categories.

CMS waived the requirement that Accountable Care Organizations (ACOs) perform Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys. CMS finalized their plan to phase in quality reporting for ACOs to meet the “Shared Savings Program” quality performance standards.

The expectation is by the 2023 performance year, ACOs achieve a quality performance score greater than or equal to the 40th percentile across all MIPS quality performance category scores.

Finally, a new reporting pathway, MIPS Value Pathway (MVP), will be adopted in 2022. It is intended to be specialty-specific and will place more emphasis on patient-reported outcomes.

For a more in-depth view of this topic, read a full-length version of this article at

Mounir Haurani, MD, Karen Woo (chair), MD, Evan Lipsitz, MD, and Jose Almeida, MD, are members of the Performance Measures Committee.


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