Merit-based Incentive Payment System (MIPS) Policies:

The Centers for Medicare & Medicaid Services (CMS) has recently unveiled the eagerly anticipated CY 2024 Medicare Physician Fee Schedule (PFS) Final Rule, shedding light on policy changes that will shape the Quality Payment Program (QPP) for the 2024 Performance Year (PY) and beyond. Set to be published on November 16 in the Federal Register, the new rule encompasses a range of pivotal alterations designed to enhance the effectiveness and efficiency of healthcare delivery.

MIPS Value Pathways (MVPs) Take Center Stage:

Among the notable highlights is the introduction of five new MIPS Value Pathways (MVPs) and modifications to all previously established pathways. The 2024 performance period will see a total of 16 MVPs available for reporting, offering clinicians a more streamlined and cohesive approach to quality reporting.

Merit-based Incentive Payment System (MIPS) Policies:

CMS has solidified policies for the 2024 performance period, impacting the MIPS performance categories. This includes a significant expansion of the quality measures inventory, now comprising 198 measures, and the MIPS inventory incorporating 106 improvement activities. Additionally, five new episode-based cost measures, each necessitating a 20-episode case minimum, have been introduced. Noteworthy is the removal of the acute inpatient medical condition cost measure, Simple Pneumonia with Hospitalization, beginning in 2024.

Advanced Alternative Payment Models (APMs) Embrace Technological Integration:

Starting in the 2024 performance period, CMS mandates that all Advanced APMs must require the use of certified Electronic Health Record (EHR) technology, underlining the agency’s commitment to fostering interoperability and technology integration.

Unaltered Thresholds and Determinations:

Crucially, CMS opted not to finalize policies that would increase the performance threshold or the data completeness threshold. For the 2024 performance period, the performance threshold remains at 75 points, and the data completeness criteria will be maintained at 75% for the 2026 performance period. Importantly, CMS will continue to make Qualifying Alternative Payment Model (APM) Participant (QP) determinations at the APM Entity level, foregoing the proposed shift to individual clinician-level determinations for the 2024 performance period.

These policy adjustments signify CMS’s ongoing commitment to refining and optimizing the QPP, aiming to strike a balance between promoting high-quality care, fostering technology integration, and ensuring fairness in performance evaluations. As you prepare for the 2024 performance period, staying informed about these changes is crucial for successful participation in the evolving landscape of value-based care.

Source: CMS