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26 | EYEWORLD DAILY NEWS | MAY 6, 2019 ASOA NEWS ASCRS ASOA ANNUAL MEETING by Ellen Stodola EyeWorld Senior Staff Writer/ Meetings Editor homes, must incorporate two-sid- ed risk to be considered advanced APMs. There are also increased participation thresholds for 2019: 50% of collective eligible patients and 35% of collective eligible revenues. Ms. McCann said that clini- cians participating in APMs that do not qualify as advanced APMs can use an APM to participate in MIPS. You report the Quality through the APM, you automat- ically receive at least 50% of the Improvement Activities score, and you report Promoting Interoper- ability on your own. APM partic- ipants all receive the same MIPS score and payment adjustment. The new ACO final rule may limit the availability of Track 1 ACOs in coming years, she added. Editors' note: Ms. McCann has no fi- nancial interests related to her comments. measures; sub-groups for ASC vs. HOPD and unilateral vs. bilater- al; and you must have at least 10 attributed cases to be scored. The measure includes pre- operative testing, the surgeon's professional fee, a facility fee, anesthesia, and costs of any additional procedures are billed separately from the global fee. The measure also includes separately payable drugs, including one on pass-through. Included drugs will be updated annually, and Ms. McCann said that ASCRS oppos- es the inclusion of pass-through drugs and is working to have them removed from the measure. Ms. McCann briefly highlight- ed advanced APMs, as the cur- rent bipartisan effort is to move physicians out of fee-for-service to advanced APMs. Clinicians participating in advanced APMs in 2019 will receive a 5% bonus in 2021 and are excluded from MIPS. APMs, such as ACOs or medical bonus, which adds 6 points to the Quality category score; and continued scoring flexibility in the Quality and Improvement Activi- ties categories. Ms. McCann discussed the low volume threshold. CMS main- tained the threshold of $90,000 in allowed Part B charges or 200 patients and added 200 or fewer Medicare professional service. A physician may opt into MIPS if he or she is above at least one of the criteria thresholds, and practices in areas with high participation in Medicare Advantage may be excluded from MIPS. Quality reporting was the last key change she highlighted. Qual- ity reporting, via Medicare Part B claims, is no longer an option for large practices of 16 or more Medicare-eligible clinicians. Small practices of 15 or fewer may now report as a group through claims but must submit the other catego- ries of MIPS as a group for CMS to score claims data collectively. Ms. McCann spoke about the 2019 MIPS category weights. Quality represents 45%, Cost 15%, Promoting Interoperability 25%, and Improvement Activities 15%. If a physician or group has no Cost measure attributed, the 15% weight is transferred to the Quality category. Additionally, if a physician or group applies for a promoting interoperability hardship exemption, the 25% weight is transferred to the Quality category. Ms. McCann addressed epi- sode-based cost measures. New episode measures were developed with input from the physician community, and ASCRS partici- pated in technical advisory panels, providing feedback on the new cataract surgery measure. The specifications of this measure in- clude: 66984 only, no complex cat- aract; 60 days preop and 90 days postop; it excludes patients with major ocular comorbidities, which is the same as the cataract quality D uring a Sunday morning ASOA course, Nanc- ey McCann, ASCRS ASOA director of government relations, Fairfax, Virginia, gave an update on "MIPS for 2019," beginning by discussing key changes for 2019. One key change is the MIPS performance threshold. The 2019 MIPS performance threshold is 30 points, increased from 15 points in 2018. Physicians and practices must score at least 30 total points to avoid a 7% penalty in 2021. The Cost category will ac- count for 15% of a physician's final MIPS score in 2019, up from 10% in 2018. The category now includes several episode-based cost measures, including one for cataract surgery. This includes five separately payable Part B drugs, including one on pass-through. Physicians and groups do not need to submit any data for this cate- gory. CMS will calculate the score based on administrative claims. Next, Ms. McCann noted the Promoting Interoperability category. The requirements and scoring have been streamlined and simplified. Participants must report on a single set of required measures. Measures requiring patient action have been removed, and health information exchange measures have been modified. All participants must use a 2015 edition certified EHR technology in 2019. There are also special ac- commodations for small prac- tices (which apply to practices of 15 or fewer Medicare-eligible practitioners). These include the promoting interoperability hard- ship exemption, which applies to reweigh the 25% weight to the Quality category; a small practice MIPS for 2019 Ms. McCann gives attendees an update on MIPS.

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