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Merit-based Incentive Payment System (MIPS)

The Medicare Physician Fee Schedule (PFS) regulation makes updates to the Quality Payment Program (QPP), the major quality reporting program for physicians under Medicare. Failure to successfully participate in the Merit-based Incentive Program (MIPS)—the main track within the QPP—could result in a 9% reduction to emergency physicians’ Medicare reimbursement. 

ACEP is doing all that we can to simplify the requirements and make it easier to avoid a penalty and even be eligible for a bonus.

Read below about MIPS and what ACEP is doing to help emergency physicians successfully participate.

Latest MIPS Updates

Final 2023 Policies

On September 6, 2022, ACEP responded to the CY 2023 PFS and QPP proposed rule. The 2023 performance year is the first year of a new reporting option in MIPS called the MIPS Value Pathways (MVPs). MVPs represent an approach that will allow clinicians to report on a uniform set of measures on a particular episode or condition in order to get MIPS credit. ACEP developed an emergency medicine-focused MVP that CMS will be including in the first batch of MVPs starting in 2023. 

Due to the COVID-19 public health emergency, hardship exemptions have been in place for the 2019, 2020, 2021, and 2022 MIPS performance periods. Therefore, for some clinicians, 2023 may be the first time they participate in MIPS in four years. 

On November 1, 2022, CMS released the CY 2023 PFS and QPP final rule.

  • For ACEP’s summary of the final rule, please click here.
  • For CMS fact sheets highlighting final MIPS policies, please click here
  • For a summary of ACEP’s response to the proposed rule, please click here.
  • For ACEP’s complete response to the proposed rule, please click here.

COVID-19 Flexibilities

CMS has announced some relief to MIPS reporting requirements due to COVID-19. CMS has created an automatic COVID-19 hardship exemption policy in 2019, 2020, and 2021. CMS has also created an application-based COVID-19 exemption policy in 2022.

Background

Most emergency physicians participate in the first track of the QPP: MIPS. MIPS includes four performance categories: Quality, Cost, Improvement Activities, and Promoting Interoperability (formerly Meaningful Use). Performance on these four categories (which are weighted) roll up into an overall score that translates to an upward, downward, or neutral payment adjustment that providers receive two years after the performance period (for example, performance in 2023 will impact Medicare payments in 2025).

MIPS Impact on Emergency Physicians

Most emergency physicians will need to participate in MIPS to avoid a penalty and perhaps get a bonus. You can report as an individual or as part of a group. For the 2023 performance year, the potential payment adjustments range between -9 and +9%.

MIPS Value Pathways (MVPs)

CMS has heard feedback, including from ACEP, that MIPS reporting should be streamlined and more meaningful to clinicians. Starting in 2023 CMS will be implementing the MIPS Value Pathways (MVPs), an approach that would allow clinicians to report on a uniform set of measures on a particular episode or condition in order to get MIPS credit. ACEP developed and proposed an emergency medicine-focused MVP, the “Adopting Best Practices and Promoting Patient Safety within Emergency Medicine MVP.” For more information on MVPs, click here.

Find Out Whether You’re Eligible

If you see a minimum number of Medicare patients, have a small amount of Medicare charges, or provide a small number of services to Medicare beneficiaries, you may be excluded. You'll need your National Provider Identifier (NPI) number to determine your eligibility.

Find out whether you must report in MIPS

What is ACEP doing?

ACEP continually advocates on behalf of emergency physicians to reduce provider burden and help our members succeed in the program. Every year, CMS updates program requirements through federal regulatory rulemaking and ACEP actively comments on these regulations. 

ACEP also provides our members with helpful tools to report in MIPS. Thousands of emergency physicians are now using CEDR to meet the Quality Reporting requirements and participating in E-QUAL to meet the Improvement Activities requirements.

MIPS Performance Categories

MIPS includes four performance categories: Quality, Cost, Improvement Activities, and Promoting Interoperability (formerly Meaningful Use). Performance on these four categories (which are weighted) roll up into an overall score that translates to an upward, downward, or neutral payment adjustment that providers receive two years after the performance period (for example, performance in 2023 will impact Medicare payments in 2025).  

In 2023, the adjustments will potentially range from –9% to +9%. In order to be eligible for a positive adjustment, a clinician’s score must exceed a certain threshold, which is 75 points in 2022 and in 2023 (proposed).

There was also an exceptional bonus for high performers, but that bonus will end after the 2022 performance year (which will impact payments in 2024). 

Quality Performance Category

To meet this requirement, most emergency physicians will have to report on six measures over a 12-month period. The Quality category will count for 30% of your total score in 2023. One great way to meet the Quality requirement is by reporting through a qualified clinical data registry (QCDR). ACEP has developed its own QCDR, called the Clinical Emergency Data Registry (CEDR). Another option available to emergency physicians for meeting the Quality category is the “facility-based scoring option.” See below for more details.

Find out more about CEDR

Cost Performance Category

Cost is automatically calculated by CMS based on two major measures: the Medicare Spending Per Beneficiary (MSPB) measure and the Total Per Capita Cost measure, as well as a set of episode-based measures. Cost will represent 30% of your total score in 2023. If these measures do not apply to you or your practice, you will not receive a cost score and your quality score will count for 60% of your total score. Another option available to emergency physicians for meeting the Cost category is the “facility-based scoring option.” See below for more details.

CMS is also in the process of developing episode-based cost measures. CMS’ contractor, Acumen, convened a workgroup that developed an emergency medicine episode-based cost measure. ACEP nominated a few individuals to serve on that workgroup, and we are pleased that three ACEP members are participating in it—including as the chair of the workgroup. We are hopeful that this measure will be proposed in next year’s rule for implementation starting in CY 2024.

Improvement Activities Performance Category

This category rewards participation in activities that improve clinical practice. There is a list of activities that are classified as either medium or high-weighted based on their value to patient care. To earn full credit in this category, participants must submit one of the following combinations of activities (each activity must be performed for 90 days or more during 2023):

  • Two high-weighted activities
  • One high-weighted activity and two medium-weighted activities
  • Four or more medium-weighted activities

A great way to meet the requirements of this performance category is by participating in ACEP’s Emergency Quality Network (E-QUAL) Initiative.

Promoting Interoperability Performance Category

This category includes measures and objectives related to the use of electronic health records (EHRs). Most emergency physicians are exempt from this category (formally known as the “Meaningful Use” program) because they are “hospital-based” clinicians who use their hospital’s EHR. CMS exempts groups from the Promoting Interoperability category of MIPS as long as 75% of individuals in the group meet the definition of “hospital-based.”

Facility-Based Scoring Option

One scoring option available to emergency physicians starting is called the facility-based scoring option for the Quality and Cost categories of MIPS.

With this scoring option, clinicians who deliver 75% or more of their Medicare Part B services in an inpatient hospital, on-campus outpatient hospital, or emergency room setting will automatically receive the quality and cost performance score for their hospital through the Hospital Value-based Purchasing (HVBP) Program. Most emergency physicians qualify for this option. Clinicians who qualify for the option can still report quality measures through another submission mechanism (such as a QCDR) and receive a “traditional” MIPS score for quality. If they do so, CMS will automatically take the highest of the HVBP score and the traditional MIPS score.

Unfortunately, due to the COVID-19 public health emergency, the facility-based scoring option has not been available for 2021 and 2022.

MIPS Value Pathways (MVP)

Performance year 2023 will be the first year that you will be able to participate in an MVP as an alternative to MIPS.  MVPs have slightly different reporting rules than traditional MIPS.

  • Quality Performance Category: MVP Participants will select 4 quality measures (rather than 6 under traditional MIPS).
  • Improvement Activities Performance Category: MVP Participants will select 2 medium-weighted improvement activities OR one high-weighted improvement activity OR IA_PCMH (participation in a patient-centered medical home).
  • Cost Performance Category: MVP Participants will be scored on the cost measures included in the selected MVP.
  • Foundational Layer: MVP Participants will select one population health measure to be calculated on. The results will be added to the quality score.
    • For the 2023 performance period, there will be 2 population health measures available for selection: Hospital-Wide, 30-day, All-Cause Unplanned Readmission (HWR) Rate or Clinician and Clinician Group Risk-standardized Hospital Admission Rates for Patients with Multiple Chronic Conditions. 
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  • Promoting Interoperability Performance Category: MVP Participants will report on the same Promoting Interoperability measures required under traditional MIPS (most emergency physicians are exempt from this category.

For more information on the emergency medicine MVP, the “Adopting Best Practices and Promoting Patient Safety within Emergency Medicine MVP,” please click here

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