Ray Painter, MD
Urology will make a modest gain overall in the 2020 final rule for the Medicare Physician Fee Schedule, although the truly significant changes won’t be felt until 2021.
The conversion factor update, as expected, is minimal for 2020; the conversion factor is set to increase to $36.09, up from $36.06. With changes in some practice expense values to some higher volume procedures, urology is projected to be up 1% overall.
MIPS and value-based programs
Medicare continues to make changes to both the alternative payment model program and Merit-based Incentive Payment System (MIPS) payment structure. Changes for 2020 for the MIPS program, under which the vast majority of urologists are measured, are focused on making the threshold to avoid penalties more difficult, increasing the number of providers who will potentially pay a penalty. Simultaneously, the rule changes the upper end of the program to attempt to decrease the number of physicians who will be awarded payments for high performance, which may increase the dollar amounts awarded to those that qualify. The combination is designed to increase participatory effort with both the carrot and the stick.
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A summary of these changes follows:
• minimum score of 45 for performance in 2020 (up from 30 for 2019)
• Quality category adjusted to 40%
• Cost category adjusted to 20%
• minimum score for exceptional performers will be raised to a minimum of 80 points
• maximum penalty for those failing to meet MIPS requirement increases to –9%, up from –7%
• penalties and bonuses will be applied to payments in 2022 based on 2020 reporting.
The rule also finalized a series of changes to go into effect in 2021 that will attempt to connect the four categories in a new “MIPS Value Pathways” proposal, which the AUA attempted to block. Changes to accountable care organizations were made as well but will not be covered in this article. We refer you to Robert Dowling, MD’s article (“How MIPS Cost category changes will affect urologists") and qpp.cms.gov for more detailed information on the Quality Payment Program.
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