Based on their practice size, specialty, location, or patient population, clinicians have two tracks to choose from in the CMS Quality Payment Program:
Participants who qualify as Advanced APM participants receive a 5% incentive for achieving threshold levels of payments and patients. All other eligible clinicians are required to participate under MIPS. Under MIPS, participants receive a positive or negative payment adjustment based on the score received on applicable weighed performance categories.
There are no 2022 APM-related changes impacting single-specialty non-patient-facing pathology groups, so the focus of this article will be on changes impacting MIPS.
Increase Performance Threshold to 75
The performance threshold increased from 60 points in 2021 to 75 points in 2022. In 2022, participants who score below 75 points will receive up to a 9% negative payment adjustment in 2024. Participants who score above 75 points will receive a positive payment adjustment. CMS also increased the exceptional Performance Threshold from 85 points in 2021 to 89 in 2022. 2022 is the last year for an additional MIPS adjustment for exceptional performance.
As a reminder, this is a budget-neutral program, which means the bonus paid under this program must be funded by the penalties applied. In 2020, the highest positive payment adjustment received was 1.87% for a score of 100 points.
Reweighting of Performance Categories Based on Special Status
Under the traditional MIPS track, participants are scored on four performance categories:
In some circumstances, CMS will reweight the performance categories, if CMS defines a category as not applicable to a participant.
The Cost performance category is evaluated automatically through administrative claims data on 23 episode-based measures identified by CMS. Non-patient-facing clinicians, such as pathologists, are not expressly exempted from the Cost category, however, CMS suggests that many non-patient-facing clinicians may not be able to be attributed to a cost measure. In previous years, the cost performance category has been reweighted to 0% by CMS for non-patient-facing pathology practices.
The Promoting Interoperability performance category promotes patient engagement and electronic exchange of information using certified electronic health record technology (CEHRT). Per CMS, non-patient-facing, small practice, or hospital-based physicians will automatically qualify for reweighting of this category to 0%.
For 2022, CMS is implementing new automatic reweighting policies for small practices. CMS defines large practices as practices with 16 or greater physicians and small practices as practices with 15 or fewer physicians.
The 2022 MIPS category weights are listed below, based on practice size and classification are listed below:
Changes to Quality Scoring
No measures were added or deleted for the Pathology Specialty Measure Set. The same six pathology measures in place for 2021 will remain in place for 2022. CMS will also maintain the Quality measure data completeness threshold at 70% for the 2022 and 2023 performance periods.
CMS has implemented the following scoring changes for quality measures including:
- Removing bonus points awarded for reporting additional outcomes or high priority measures beyond the one required.
- For new measures, established a 7-point floor for the first performance period and a 5-point floor for the second performance period. Typically, new measures are awarded 3 points.
- For small practices reporting Quality measures through claims, CMS will only calculate a group score if the practice submitted data for another performance category as a group.
- For large practices that don’t meet the 70% data completeness on a measure, CMS is removing the 3-points floor. These measures will be scored on 1 to 10 points versus a 3 to 10 points scale. For small practices, the 3-point floor will remain for not meeting data completeness.
New Pathology Related Improvement Activity
CMS is implementing the College of American Pathologists (CAP) proposed improvement activity (IA_ERP_5) on implementing a laboratory preparedness plan to support continued or expanded patient care during COVID-19 or another public health emergency.
Shift to MIPS Value Pathways (MVPs)
In the 2022 Program Final Rule, CMS acknowledges some of the challenges of the traditional MIPS program and therefore has finalized a plan to transition to MIPS Value Pathways (MVPs). MVP measures are designed to connect measures and activities across the quality, cost, and improvement activities performance categories of MIPS for different specialties or physicians. MVPs will be voluntary for the 2023 to 2027 performance year.
CMS has finalized 7 MVPs that will be available, beginning with the 2023 performance year. Each MVP includes complementary measures and activities and supports continued emphasis on the importance of patient outcomes and reduced reporting burden for clinicians.
Seven MVPs for the 2023 Performance Year
8 Key Take-Aways for Pathology Practices
1. Focus on Avoiding the Penalty
The new focus on MIPS is more about avoiding a penalty versus achieving a positive payment adjustment. When the program was first implemented, the goal was to achieve the highest score possible and obtain a potential positive payment adjustment on Medicare claims. As the program has evolved the goal has transitioned from obtaining a positive payment to avoiding a negative payment adjustment.
2. Harder to Achieving Performance Threshold
With increases each year, it becomes more difficult to achieve the performance threshold. This is especially difficult for pathology practices because each measure under the CMS OPP Pathology Specialty Set is topped out at 7 points but still scored on a 10-point scale.
3. New Measures Earn More Points
CAP has developed pathology-specific quality measures that can only be reported to CMS through the CAP’s Pathologists Quality Registry tool. In the past, because these were new measures without a benchmark, they were awarded 3 points. In 2022 new measures, will receive a 7points in the first performance period and 5 points in the second performance period.
4. CAP Measures Worth 10 Points
Two CAP-developed measures now have a benchmark that should be awarded 10 points (CAP28: H. Pylori and CAP 32: Prostate Cancer Gleason Pattern).
5. Small Practices Bonus
For small practices, the reweighting of performance categories to 50% Quality and 50% Improvement Activities should result in higher scores. Small practices will also continue to earn 6 Quality bonus points.
6. Large Practices Should Evaluate CAP Registry
Large practices may want to evaluate CAP’s Pathology Registry to gain access to CAP pathology-specific measures worth 10 points. If a large practice reports on the 6 CMS QPP quality measures, maximizes each measure and receives full credit for improvement activity, their final score will be 74.5 points.
6 CMS QPP Measures – Large practices maximizing each measure will earn 59.5 points for Quality [(6 measures x 7 points)/60total points x 85% x 100) and 15 points for improvement activities. 74.5 total points
4 CMS QPP Measures and 2 CAP QCDR Measures worth 10 points – Large practices maximizing each measure will earn 68 points for Quality [(4 measures x 7 points + 2 measures x 10 points)/60total points x 85%x 100) and 15 points for improvement activities. 83 total points
7. Don’t Forget Improvement Activities
Quality by far is the most complicated measure for pathologists and requires monthly evaluation by the participating group. However, to achieve the performance threshold it is essential pathology practices, continue to also report on improvement activities.
8. Start Preparing for 2022
MIPS participating clinicians should begin focusing on 2022 MIPS now and evaluating their MIPS scores monthly. Most registry companies require an annual registration and have a deadline around June. In addition, tracking your MIPS score monthly allows clinicians to make informed decisions on how to maximize performance in each category or take steps to avoid a penalty.
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2022 Quality Payment Program Final Rule Resources: Located on the CMS QPP Resource webpage, the link to the 2022 Program includes a fact sheet, comparison tables, and FAQs.
CAP Quality Payment Program for Pathologists: Located on the CAP website under Advocacy, this section includes additional information on CAP’s Pathologist Quality Registry, 2022 MIPS Quality Payment Program, and CAP QCDR registry-specific measures.