MIPS 2025: What Clinicians Need to Know About Proposed Rule Changes
As we approach 2025, the Centers for Medicare & Medicaid Services (CMS) has announced several revisions and proposals that will affect the Merit-Based Incentive Payment System (MIPS) and its reporting process. While some aspects remain unchanged, there are notable adjustments aimed at enhancing fairness, accuracy, and the overall evaluation of clinicians. This article will break down these changes within each category and what is remaining the same.
MIPS Reporting for 2025
General Reporting Structure: Categories hold the same percentages as they did in previous years, providing consistency for physicians and practices.
Performance Threshold: CMS has proposed that the 75 point threshold remains the same and will continue with this benchmark.
Quality Category
Increased Emphasis on Outcome Measures: The quality category will be more challenging due to a stronger focus being placed on outcome measures.
New Benchmarking Approach: CMS plans to introduce a new method for benchmarking measures impacted by limited choices, aiming to ensure fairer evaluations.
Revised Scoring Range: Measures are no longer capped at 7 points; the new range is 1-10 points. The 97th percentile corresponds to 7.5 measure points, providing a more nuanced performance assessment.
Cost Category
Revised Scoring Methodology: The scoring for the cost category will now incorporate a system that incorporates standard deviation and median values. This methodology will provide a more accurate reflection of performance by considering the distribution of scores amongst physicians and practices.
Promoting Interoperability
No new changes have been proposed, maintaining current requirements.
Improvement Activities
Modifications: CMS is introducing significant changes to the Improvement Activities category. This includes the addition of 2 new activities, the removal of 8 existing ones, and the modification of 2 current activities.
Elimination of Certain Improvement Activities and Weighing: As 2025 approaches, the list of available activities will be streamlined, and medium weighted activities will be eliminated. In addition, CMS has proposed eliminating the concept of weighing these activities completely, simplifying the evaluation process for clinicians.
MVPs
Six new MVPs introduced: Dermatological, Gastroenterology, Ophthalmologic, Urologic, Pulmonology, and Surgical Care.
APP Plus
A New Reporting Pathway: APP Plus will include 6 APP quality measures, and 5 more measures will be expected to be included by 2028. Increased number of measures will ease the burden of adopting new measures while lowering the impact of low performance on singular measures.
Medicare CQMs
Key Takeaways to Medicare CQM Collection: For the initial two performance periods under MIPS, Medicare CQMs will adopt flat benchmarking, which will benefit higher-performing ACOs.
ACOs
Revisions Being Made to Definition of Primary Care Services: Additional HCPCS and CPT codes to be included.
Adjustments for Virtual Groups and APM Entities: 1 point per submitted eCQM, no adjustment if reporting both eCQMs and Medicare CQMs. Each measure is capped at 10 points and cannot exceed 10% of total points for the quality performance category.
To ensure your practice is updated and aligned with these changes, take proactive steps now. Visit chirpybirdinc.com or contact us today!
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