Healthmonix Media Coverage

QPP changes arrive, as later reporting, payment hassles loom

Posted by Healthmonix on Jan 23, 2023 3:00:51 PM

by Ron Edroso

Take stock of a series of annual updates to the Quality Payment Program (QPP) and Merit-based incentive Payment System (MIPS) to succeed in 2023, but watch carefully as CMS prepares for a whole new MlPS paradigm and, for alternative payment model (APM) participants, a possible year without bonuses down the road. 

Changes to the QPP in 2023 - MIPS Value Pathways

The 2023 numbers are no surprise: As proposed, the MlPS category weights will be 30% for Quality, 30% for Cost, 15% for Improvement Activities and 25% for Promoting Interoperability. The data completeness threshold rises from 70% to 75%, and the performance threshold remains 75 points. CMS finalized all its earlier proposed weights. 

The most MIPS reporters can be penalized for missing these targets is 9% of payments, while the amount of the positive adjustment for meeting the reporting targets will be based on how many positive reporters are in the program - given the near-100% positive reporting rate in the program, positive adjust­ments are likely to be a very small amount. As for the additional positive payment adjustment for "exceptional performance,'' that is phased out starting in 2023. 

A deeper look at the measures 
Nine of the proposed new Quality measures were finalized, including ''Improvement in Patient-Reported Itch Severity" for psoriasis and dermatitis patients; 
"Screening for Social Drivers of Health"; and "Adult lmmunization Status." The agency cut 11 measures, including "Biopsy Follow-Up" and "Leg Pain After Lumbar Fusion," making the final tally 198 measures, down from 200. 

In 2023, the Cost category score will be calculated by CMS based on achievement and a year-to -year improvement in the '·Total Per Capita Cost (TPCC)" and "Medicare Spending Per Beneficiary (MSPB) Clinician" measures. (Previously, CMS notes, all participants received a score of zero ''because we didn't calculate cost measure scores for the 2021 performance period" to base improvement on.) The maximum improvement score will be 1 percentage point out of 100 percentage points available. 

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Topics: MIPS Value Pathways, 2023 PFS Final Rule