- As of November 2022, The Centers for Medicare & Medicaid Services (CMS) released the Final Rule for the Calendar Year 2023 Medicare Physician Fee Schedule (PFS) and Quality Payment Program (QPP) which determines the regulatory reporting needs for practices, such as the Merit-Based Incentive Payment System (MIPS).
- CMS designed MIPS to tie payments to quality, drive improvement in care processes and health outcomes, increase the use of healthcare information and reduce cost.
- Reporting can be complex for healthcare organizations to handle. Practices are turning to PINC AI™ Eligible Clinicians (EC) Quality Measurement solution to help manage data collection, measure calculation, and satisfy MIPS submission reporting requirements for eligible clinicians and groups.
CMS recently released the 2023 Medicare PFS and QPP final rule. According to CMS, the rule is one of several that reflect a broader administration-wide strategy to create a more equitable healthcare system that results in better accessibility, quality, affordability and innovation. CMS remains committed to promoting more meaningful participation in the QPP for clinicians and creating policies that continue to drive value and improved health outcomes for patients.
There are currently two QPP participation tracks; first is the MIPS and the second is Alternative Payment Models (APM). CMS is adding a third track effective with Calendar Year 2023. Below, we highlight the requirements needed for these tracks.
QPP Participation Tracks
MIPS will have three options for participation. One is Traditional MIPS, the second is APM Performance Pathway (APP) and a new option in 2023 is MIPS Value Pathways (MVPs). MIPS-eligible clinicians can choose their participation track of either Traditional MIPS or MVPs to avoid up to a nine percent negative payment adjustment in the 2025 payment year.
An individual clinician is eligible for MIPS if they bill more than $90,000 for Medicare Part B covered professional services, see more than 200 Part B patients and provide 200 or more covered professional services to Part B patients. The MVP framework aligns quality, cost, improvement activities across conditions, specialties and care processes. The framework includes a foundational layer of population health measures and Promoting Interoperability requirements. There are 12 MVPs that providers can select from to meet their MIPS reporting requirements.
For the MIPS 2023 Performance Year, successful participation requires meeting the minimum final score threshold of 75 points. Achieving a final score of 75 earns a neutral payment adjustment. A final score above 75 may earn an incentive payment. The score is calculated based on the performance results from the four MIPS categories: Quality, Cost, Improvement Activities and Promoting Interoperability.
Many APMs have specific reporting requirements. Medicare Shared Savings Programs (MSSP) Accountable Care Organizations (ACOs) are required to report the APM Performance Pathway (APP). CMS is sunsetting ACO Web Interface reporting effective with the 2025 Performance Year, requiring the ACOs to report on all payers. Performance Years 2023 and 2024 will allow ACOs time to transition to all-payer reporting and the three quality measures within APP.
Driving MIPS Success with the PINC AI™ EC Quality Measurement Solution
The COVID-19 pandemic has resulted in reporting eligibility changes for many organizations, and as we proceed into the future, it is important to understand that annual program requirements evolve. It can be challenging to report confidently in an ever-changing set of regulatory requirements while acknowledging that this is just one program that resides among so many other responsibilities.
Manage data collection, measure calculation and satisfy 2023 MIPS submission requirements through PINC AI™ EC Quality Measurement technology. Premier, an Office of the National Coordinator for Health Information Technology (ONC) Certified Health IT vendor, offers PINC AI™ users the ability to calculate all eligible clinicians (EC) electronic clinical quality measures (eCQMs) as a comprehensive set for performance improvement. In addition, this web-based technology builds upon reporting capabilities in previous program periods with easy data collection to measure performance and complete regulatory reporting throughout the year.
Projected scores display within an interactive dashboard for each measure and MIPS category, enabling overall score projections and the identification of opportunities for improvement. Most importantly, you don’t need to navigate this ever-changing program alone. Partner with the team behind the PINC AI™ technology for guidance through complex regulatory requirements, management of timelines and help with understanding measure performance. As a result, you are more equipped to improve patient care and quality reporting.
Premier is expanding QPP participation support for eligible clinicians beyond traditional MIPS and APP for MSSP ACO reporting to support MVPs effective with the 2023 performance year. While CMS continues to evolve, get a head start by electing to report one of the available MVPs. You can report both traditional MIPS and MVPs, and CMS will use the highest final score.
The spirit of the QPP has always carried the message of improving the quality of care for the American Medicare population, and this population is only growing. Between 2021 and 2022, the number of Medicare beneficiaries increased by 8 percent, and it is anticipated that it will rise to 61 percent by 2032. The growth of this aging population will result in even larger patient populations. There’s no better time than now to utilize the PINC AI™ EC Quality Measurement solution to help measure and improve the quality of care you’re providing to this community.
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