Nearly one million providers participate in Merit-based Incentive Payment System (MIPS), not only to try for a bonus payment, but also to monitor the quality of their patients’ care. MIPS is a program offered by the Centers for Medicare & Medicaid Services (CMS) that rewards top performance in preventative care. Knowing the changes to CMS quality measurement criteria can be key in how easily you are able to meet your quality goals.
Scoring can result in either a positive, negative, or neutral payment adjustment. So, if you score above a certain threshold, you then earn the bonus, but scoring below the line results in a penalty. Having a clear understanding of quality measures is one of the most effective ways to avoid penalties, focus your quality improvement efforts, and increase your chances of earning a bonus.
The goal of MIPS measures is to improve healthcare quality and health outcomes by rewarding providers for meeting various quality goals. Knowing which measures are being used and how they will score you is key in avoiding penalties or earning a bonus. Below is our list of MIPS quality measures changes and specifications clinicians should be aware of.
1. New MIPS Quality Measures for 2023
For the first time in 2023, MIPS quality measures are available for reporting. Since these quality measures have not been reported before, historical data from CMS is not currently available for benchmarking.
A clinician or group reporting one of these quality measures will initially earn three points for the measure, assuming the data completeness criteria are met. If enough clinicians or groups report the measure for 2023, CMS may be able to create benchmarks based on performance year data. In that case, reporting clinicians or groups may earn more than three points, depending on performance compared to others who report the measure.
Because scoring for new measures is unpredictable, Medical Advantage’s MIPS Consultants recommend that practices report new measures as additional measures – rather than as one of their top six required measures. Keep in mind that because the measures are new, EHR vendors may not have updated the system to reflect measures for 2023 CMS quality public reporting.
2. Deleted Measures: Choosing Replacement Measures
Deleted measures are quality measures that CMS has removed from the MIPS quality reporting program. If a clinician or group reported any deleted measures in 2022 as one of their six required quality measures, they will need to choose a replacement measure for 2023.
3. Topped-Out Measures: What Clinicians Should Know
Topped-out quality measures have an overall performance rate so high that meaningful performance distinctions and improvements can no longer be made. CMS has a multi-year phase-out cycle for topped-out quality measures. This includes a seven-point cap for measures that have been classified as topped-out for two or more consecutive years.
Clinicians who report a topped-out measure with a seven-point cap will score no more than seven points for that measure, even if they report a perfect performance rate of 100%. For maximum scoring potential, clinicians and groups are encouraged to report topped-out measures with a seven-point cap only as additional measures above the required six measures.
4.MIPS 2023 New Improvement Activities
CMS has added four new Improvement Activities for Year Seven. As a reminder, physicians must achieve a total of 40 points from Improvement Activities during a 90-day reporting period by 50% of their clinicians.
CMS will score activities as either high- or medium-weighted. High-weighted activities are worth 20 points, while medium-weighted activities are worth 10 points. Certain clinician types (such as those in small practices) automatically receive double the assigned points for their Improvement Activities.
View our chart below for the new quality measures in 2023. Want to view all the updates for 2023? Click here to download our 2023 Quality Measures Guide
5. MIPS 2023 Deleted Improvement Activities
CMS has removed six Improvement Activities from the list of available options for 2023. Reasons for Improvement Activity removal include reduction of duplicative activities, alignment with current best practice clinical guidelines, meaningful measures initiative, and lack of utilization in prior MIPS reporting years.
How Do Healthcare Consultants Help With CMS Quality Measures?
With MACRA constantly changing from year to year, it can be challenging for practices to keep up with the quality payment program. Now is the perfect time to consider partnering with CMS experts like Medical Advantage’s MIPS Consultants for personalized one-on-one support.
Our MIPS consultants have years of experience working as practice managers, nurses, and billing specialists. Value-add comes from our personalized one-on-one support.
Medical Advantage also invites providers to join our accountable care organization (ACO) for comprehensive support with a variety of quality initiatives including MIPS. Get in touch today for a free consultation to find out how our services can support your practice and continue improving quality of care.