AE July/August 2018 Vol 27 No 4 - 25

2018 is another transition year-which
allows participants to submit minimal
data to avoid the penalty-and coupled
with key policy and statute changes,
practices have several options to consider.
We've compiled some key tips for
ophthalmology practices as they continue
in this second year of MIPS.
small practices mentioned above,
such as the automatic 5-point
bonus, the hardship exemption,
the increased activity weighting for
Improvement Activities, and the
three-point minimum for quality
measures, all still apply even if you
are only submitting enough data
to avoid a penalty. There are multiple ways to meet the threshold.
MIPS doesn't require an EHR:
Physicians who do not use EHRs
are still able to participate in MIPS
to avoid a penalty-and may even
be eligible for a small bonus in
2020. For those in small groups,
the small practice hardship exemption will allow practices to apply
and have the weight of the category re-assigned to Quality. If you
participate fully in the Quality and
Improvement Activities categories,
you may score high enough to
receive a bonus in 2020. Quality
can be reported through claims or
registry, and Improvement Activities can be reported through the
registry or CMS site.
Aim for the 70-point exceptional
performance threshold to ensure
a 2020 bonus: Similar to last year,
the transition flexibility means that
most physicians will avoid a penalty, and so there will not be much

money available to redistribute as
bonuses. However, the exceptional
performance threshold remains at
70 points, and practices scoring
above it can tap into separate,
non-budget-neutral funds Congress
set aside. ASCRS continues to
recommend that any practice that
wants to earn a 2020 bonus should
seek to score at least 70 points.
Cost now counts for 10% of
your MIPS score: CMS increased
the weight of the Cost category
to 10% of the 2018 score, up
from 0% in 2017. However, as a
result of technical corrections to
the MACRA statute advocated by
ASCRS*ASOA, CMS may keep
weight at below 30% for three
additional years. For 2018, CMS
finalized two measures for this category: total per capita cost of care
and Medicare spending per beneficiary (MSBP). These measures
are attributed to practices through
the same flawed two-step methodology used in the now-sunsetted
Value-Based Payment Modifier
program that attributes the total
cost of care for a patient first to
the primary care physician s/he
sees the most in the year. If the
patient didn't see any primary
care physician during the year,

the total cost of the patient's care
is attributed to whatever doctor
billed the plurality of E/M visits,
which could be an ophthalmologist. While the MSPB measure is
in-patient based, and not likely to
be attributed to an ophthalmology practice, some ASCRS*ASOA
members may be attributed the
total per capita cost measure. If no
cost measures are attributed to a
group, the weight of the category
reverts to the Quality category.
Next year, we expect CMS to
include a new episode-based cost
measure for cataract surgery as
part of this category. You can view
draft feedback reports for the
cataract measure in your CMS
Qualitynet portal. AE
Allison Madson (703591-2220; amadson@
ascrs.org) is manager of
regulatory affairs at
ASCRS*ASOA,
Fairfax, Va.

HOW TO LEARN MORE
This article pulled together
some of the top items to
consider as you report MIPS
in 2018. As always, detailed
guides on each of the categories, more top tips, FAQs,
and other resources are available at the ASCRS*ASOA
MACRA Center webpage
ascrs.org/macracenter
(ASOA members log-in with
the same credentials as the
ASOA website).
Have another burning
question? Call the MACRA
Hotline at 703-383-5724.

www.asoa.org // AE

25


http://www.ascrs.org/macracenter http://www.asoa.org

Table of Contents for the Digital Edition of AE July/August 2018 Vol 27 No 4

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