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Become a Member
Become a member and receive career-enhancing benefits

Our top priority is providing value to members. Your Member Services team is here to ensure you maximize your 鶹ýmember benefits, participate in College activities, and engage with your 鶹ýcolleagues. It's all here.

Membership Benefits
ACS

2021 MACRA Quality Payment Program

How It Works

4-Category Measurement

Merit-Based Incentive Payment System (MIPS) is the default QPP participation pathway for most physicians. MIPS is composed of four performance categories, which contribute a specified weight to the overall MIPS final score: Quality,Improvement Activities, Promoting Interoperability, and Cost.

Scoring Overview

  • In 2021, surgeons will need to score a total of at least 60 points to avoid a payment penalty in 2023.
  • CMS will assign a MIPS final score to individual clinicians, group practices, virtual groups, and alternative payment model (APM) entities. The final score reflects performance across the four categories and can range from 0 to 100 points.
  • Surgeons can receive positive, neutral, or negative payment adjustments based on their final score (see diagram below).
  • If a surgeon or group is required to report MIPS and chooses not to in 2021, they would receive the full -9 percent Medicare payment adjustment in 2023.

Surgeons seeking assistance in planning for 2021 QPP and MIPS participation or understanding their 2020 MIPS feedback reports should e-mail qualityDC@facs.org.

Apply for a 2021 MIPS Exception

For 2021, the Extreme and Uncontrollable Circumstances Reweighting Application allows individual clinicians, group practices, and APM Entities to request reweighting for any or all MIPS performance categories if their ability to participate in MIPS is disrupted by a natural disaster or public health emergency (e.g. the COVID-19 pandemic).

Learn How

Quality Reporting Options

Beginning with the 2021 MIPS Performance Year, the 鶹ýSurgeon Specific Registry (SSR) will no longer support CMS MIPS reporting. However, the Centers for Medicare and Medicaid Services (CMS) offers multiple options for submitting your quality measure data for MIPS 2021 performance year.

Learn More

Facility-Based Scoring

CMS will automatically use the Hospital Value-Based Purchasing (VBP) Program score of a facility-based clinician or group in lieu of a Merit-based Incentive Payment System (MIPS) score if the VBP score is higher than the clinician's combined Quality and Cost score under MIPS. CMS calculates the facility-based score automatically using the facility's Total Performance Score determined through the Hospital VBP Program. Surgeons are not required to opt-in or take any specific action to be eligible, but should use theto determine whether they meet the definition of "facility-based" and to which facility they are attributed. Surgeons who are eligible for facility-based scoring can still report MIPS Quality measures, but CMS will automatically use the facility's score if it is higher than their combined Quality and Cost MIPS scores. CMS will provide details about how surgeons were scored for MIPS through the 2020 MIPS feedback reports, which are expected to be released in July 2021.

Individual clinicians are considered facility-based if they meet all the following criteria:

  • Billed at least 75 percent of covered professional services in a hospital setting.
  • Billed at least one service in an inpatient hospital or emergency room and can be attributed to a facility with a Hospital VBP score.
  • If a clinician works at multiple facilities, CMS will attribute the clinician to the hospital where they provided services to the greatest number of Medicare beneficiaries during the determination window using the same TIN/NPI combination.
  • A group practice would be considered facility-based if 75 percent or more of the MIPS-eligible clinicians in a group are deemed facility-based. CMS will attribute the group to the hospital where the plurality of clinicians in the group were attributed as individuals.

For the 2021 MIPS performance year, CMS will rely on FY 2022 Hospital VBP Program scores for facility-based scoring. FY 2022 hospital scores will not be released to the public until early in 2022, but clinicians should be able to view FY 2021 hospital scoresin early 2021 to get a general sense of where a facility falls compared to others. Some surgeons are tied to high-performing facilities and could rely on the facility score to achieve a high MIPS score, but that may not be the case for all, making it important to understand how your facility has historically scored and compared with other facilities in the Hospital VBP Program.

Please note:Hospital-based status is different than facility-based status. Hospital-based status has different eligibility criteria and is used to determine if a clinician or group is exempt from the Promoting Interoperability (PI) category. As mentioned, facility-based status is used to determine whether the clinician or group is eligible for facility-based scoring. Although the statuses are different, it is possible to fall into both categories. Surgeons who are considered both hospital-based and facility-based will receive an automatic reweighting of PI to Quality and are also eligible to have their facility's Hospital VBP Program score applied to Quality and Cost.