CMS Releases the 2022 QPP Proposed Rule – What You Need to Know

Posted On: August 25, 2021

On July 13, 2021, CMS released the Quality Payment Program’s 2022 Proposed Rule.  Based on the contents, is clear that CMS intends to move forward with their plan to eventually replace traditional MIPS with MIPS Value Pathways (MVP) but in the meantime, a variety of changes are directed to all aspects of the current program.  The Proposed Rule is open for comment by stakeholders (that means you) until September 13, 2021.  This article highlights the important proposed changes that will impact future reporting.

Traditional MIPS Proposed Changes

MIPS Eligible Clinician Types

CMS proposes to expand the definition of a MIPS eligible clinicians to include:

• Clinical Social Workers
• Certified nurse mid-wives

This change is proposed to align to the APM eligible clinician definition.  CMS anticipates that both clinician types will have an appropriate level of quality measures and Improvement Activities.

CMS also proposes that Clinical Social Workers may automatically reweight to zero for the Promoting Interoperability category of MIPS.

No clinician types have been proposed for removal from the eligible clinician definition.

MIPS Performance Thresholds

CMS will follow statute beginning with the 2022 performance year.  Statute requires that that the performance threshold must be either the mean or median of the final scores for all MIPS eligible clinicians for a prior period.

Therefore, CMS proposes the use of the mean final score from the 2017 performance year/2019 payment year to set the 2022 performance threshold.  This results in the following:

• Performance threshold is set at 75 points
• Additional performance threshold would be set at 89 points for exceptional performance
• 2022 performance year is the final year for an additional performance adjustment based on exceptional performance!  Beginning in 2023, only penalty dollars will be used to fund the program.  We expect to see a greater number of providers falling subject to negative payment adjustments as program changes make it more difficult to fall on the right side of the performance threshold.

Performance Category Weights

Traditional MIPS:

Also required by statute, the performance category weights for Quality and Cost will finally equalize at 30 percent each.  Improvement Activities and Promoting Interoperability categories remain unchanged from 2021 performance year levels :

 

For Traditional MIPS APM Entities, the scoring will be unchanged from the 2021 PY.

For APP: Individuals, Groups and APM Entities, the scoring will be unchanged from the 2021 PY.

Traditional MIPS: APM Entities (no change)

• Quality: 55%
• Cost: 0%
• Promoting Interoperability: 30%
• Improvement Activities: 15%

APP: Individuals, Groups, APM Entities (no change)

• Quality: 50%
• Cost: 0%
• Promoting Interoperability: 30%
• Improvement Activities: 20%

Performance Category Specific Proposals

Quality Performance Category

The following changes are proposed for the 2022 Quality performance category:

Collection Types

CMS proposes to extend the CMS Web Interface in traditional MIPS for registered groups, virtual groups and APM Entities with 25 or more clinicians.

• The CMS Web Interface was to originally finalized to sunset as a collection type for the 2022 PY.

The following collection types remain available for traditional MIPS Quality category reporting for the 2022 PY:

• Electronic Clinical Quality Measures (eCQMs)
• Medicare Part B Claims Measures
• MIPS Clinical Quality Measures (MIPS CQMs)
• QCDR Measures

Quality Measures

CMS proposes changes to the Quality Measure inventory.  The proposed inventory will have a total of 195 quality measures for the 2022 PY.  These changes include:

• Substantive changes to 84 existing MIPS quality measures.
• Changes to specialty sets.
• Removal of measures from specific specialty sets.
• Removal of 19 quality measures.
• Addition of 5 quality measures, including 2 new administrative claims measures.

The 2 proposed administrative claims measures are:

1. Risk-Standardized Acute Unplanned Cardiovascular- Related Admission Rates for Patients with Heart Failure for the Merit-based Incentive Payment System
   1. 21-case minimum
   2. 1-year performance period (January 1 – December 31)
   3. Applies to MIPS eligible clinicians, groups, and virtual groups.
2. Clinician and Clinician Group Risk-standardized Hospital Admission Rates for Patients with Multiple Chronic Conditions
   1. 18-case minimum
   2. 1-year performance period (January 1 – December 31
   3. Applies to MIPS eligible groups with at least 16 clinicians

(See Appendix A / Table A for measure change details)

Benchmarks

Extreme and Uncontrollable circumstances policies in effect due to COVID-19 will impact benchmarking sources in 2022.  CMS proposes to use performance period benchmarks or benchmark data from another performance period, such as CY 2019, to establish benchmarks.

• This proposal is pending the analysis of 2020 performance year data.

Data Completeness

CMS proposes to maintain the current data completeness threshold at 70% for the 2022 performance year

• An increase of the data completeness threshold to 80% for the 2023 performance year has also been proposed

Quality Measure Scoring

Currently, there is no policy in place to address new measure scoring other than to award 3 points for measures without a benchmark.  In preparation to align Quality Measure Scoring with MVPs, and to move away from scoring methodology used during the transitional phase of MIPS, CMS proposes the following:

For New Measures – During the first 2 performance periods for a new measure, CMS proposes to create a 5-point floor scoring model.  This would work as follows:

• A new measure available beginning with the 2022 performance period could earn 5-10 points in the 2022 and 2023 performance periods if a performance period benchmark could be created.
• The measure would earn 5 points in the 2022 and 2023 performance periods if no performance period benchmark could be created as long as data completeness and case minimum criteria were met.

Measures with a benchmark – CMS proposes to remove the 3-point floor for measures that can be scored against a benchmark

• These measures would be worth between 1 and 10 points.

Measures without a benchmark – Currently 3 points are awarded to these measures.  CMS proposes to remove the 3-point floor for measures that do not have a benchmark for PY 2022.

• These measures would receive zero points
• Small practices (15 or less eligible clinicians) would continue to earn 3 points for participating in these measures

Measures that do not meet case minimum (20 cases) – Currently 3 points are awarded to these measures.  CMS proposes to remove the 3-point floor.

• These measures would receive zero points
• Small practices (15 or less eligible clinicians) would continue to earn 3 points for participating in these measures

Bonus Points

CMS proposes to remove the ability to earn bonus points for both High-Priority measure reporting and End-to-End Electronic Reporting.

Quality Scoring Flexibilities

CMS proposes to expand the list of reasons that a quality measures may be impacted to include errors that cause to suppress or truncate a measure. These errors include, but are not limited to:

• Changes to the active status of codes.
• The inadvertent omission of codes.
• The inclusion of inactive or inaccurate codes.

Scoring for Groups reporting Part B claims measures

CMS proposes to only calculate a group-level quality performance category score from Medicare Part B Claims measures if the practice submitted data for another performance category as a group (signaling their intent to participate as a group).   This will differ from the previous method to automatically calculate at individual and group levels for small practices.

Cost Performance Category

Measure Additions

CMS proposes to add 5 new episodic-based cost measures:

• 2 procedural measures (melanoma resection (10 episodes), colon and rectal resection (20 episodes))
• 1 acute inpatient measure (sepsis (20 episodes))
• 2 chronic condition measures (diabetes (20 episodes), asthma/chronic obstructive pulmonary disease {COPD} (20 episodes)
  • The Chronic Condition measure category would be a new measure type for the Cost performance category

2020 Category Reweighting

Due to Covid-19, CMS determines that they cannot reliably calculate scores for the Cost measures, therefore, a weight of zero will be assigned to the cost performance category for the 2020 performance year/2022 payment year.

Improvement Activities Performance Category

Along with proposals directed towards processes guiding addition of new and removal of existing activities due to obsolescence or patient safety concerns, CMS is proposing the addition of 7 new improvement activities and modification to 15 current activities and removal of 6 activities.

See Appendix A / Table B for the IA list

Promoting Interoperability Performance Category

The proposed rule deals out its fair share of changes in the PI category of MIPS.  For 2022, CMS proposes the following:

Reweighting – to automatically apply reweighting to two clinician types

• Clinical Social Workers
• Small Practices
  • Distribution of the PI category would result in the following reweights to the final MIPS score:
    • Quality – 40% (increases by 10)
    • Cost – 30 % (unchanged)
    • Improvement Activities – 30% (increases by 15)
  • Small practices may still opt to participate in the PI category.

Revision of Reporting Requirements

• Public Health and Data Exchange objective to support PHA (public health agencies) in future health threats and long term Covid-19 recovery by requiring eligible clinicians to report:
  • Immunization Registry Reporting (unless excluded)
  • Electronic Case Reporting (unless excluded)

Revision of Measure – Provide Patients Electronic Access to the Health Information

• CMS proposes to modify this measure to require that PHI remain available to the patient (or patient-authorized representative) to access indefinitely, starting with a date of service of January 1, 2016.

New Measure

• CMS Proposes that a new attestation-based PI Measure – Safety Assurance Factors for EHR Resilience Guides (SAFER Guides)
  • Eligible Clinicians would have to attest to conducting an annual assessment of the High Priority Guide of the Safety Assurance Factors for EHR Resilience Guides (SAFER Guides)
  • https://www.healthit.gov/sites/default/files/safer/guides/safer_high_priority_practices.pdf

Attestations

• CMS proposes language and other modifications to the Prevention of Information Blocking attestation statements to distinguish it as separate from the ONC Cures Act Final Rule Information Blocking policies.

Public Reporting – Care Compare

CMS Proposes to add affiliations for the following facility types on Care Compare:

• Long-Term Care Hospitals
• Inpatient Rehabilitation Facilities
• Inpatient Psychiatric Facilities
• Skilled Nursing Facilities
• Home Health Agencies
• Hospice
• End-Stage Renal Disease (ESRD) Facilities

Complex Patient Bonus 

• Continue doubling the complex patient bonus for the 2021 MIPS performance year/2023 MIPS payment year. These bonus points (capped at 10-points) would be added to the final score.

CMS also proposes to revise the complex patient bonus beginning with the 2022 MIPS performance year/2024 MIPS payment year by:

• Limiting the bonus to clinicians who have a median or higher value for at least one of the two risk indicators (HCC and dual proportion).
• Updating the formula to standardize the distribution of 2 two risk indicators so that the policy can target clinicians who have a higher share of socially and/or medically complex patients.
• Increasing the bonus to a maximum of 10.0 points.

Medicare Shared Savings Program

For performance year 2022, ACOs would either report the 10 CMS Web Interface measures or the 3 eCQMs/MIPS CQMs. Under the APP, all ACOs would administer the CAHPS for MIPS Survey and be scored on 2 administrative claims-based measures (calculated by CMS).

• The following measures do not have benchmarks for performance year 2022 and therefore will not be scored but will still require to be reported in order to complete the CMS Web Interface Data set:
  • (Statin Therapy for the Prevention and Treatment of Cardiovascular Disease (Quality ID# 438),
  • Depression Remission at Twelve Months (Quality ID# 370), and
  • Preventive Care and Screening: Tobacco Cessation: Screening and Cessation Intervention (Quality ID# 236))
• Measure inclusion in the calculation of the ACO’s quality performance score will be based on the ACO’s chosen reporting option
  • Web Interface or the eCQMs/MIPS CQMs, either 6 or 10 measures
  • CMS Web Interface – 7 measures,
  • CAHPS for MIPS Survey – 1 measure,
  • Administrative claims-based measures – 2 measures

For performance year 2023, ACOs would either report the 10 CMS Web Interface measures and at least one eCQM/MIPS CQM or the 3 eCQMs/MIPS CQMs. Under the APP, all ACOs would continue to administer the CAHPS for MIPS Survey and be scored on 2 administrative claims-based measures (calculated by CMS).

In order to transition ACOs to reporting all-payer eCQM/MIPS CQM measures, CMS would only score the CMS Web Interface measure set for an ACO that has also submitted at least one eCQM/MIPS CQM measure.

• The following measures do not have benchmarks for performance year 2023 and therefore will not be scored:
  • (Statin Therapy for the Prevention and Treatment of Cardiovascular Disease (Quality ID# 438),
  • Depression Remission at Twelve Months (Quality ID# 370),

Coupled with CMS’ proposed revisions to the quality reporting requirements for the Shared Savings Program, they are proposing to freeze the quality performance standard at the 30th percentile MIPS quality performance category score for PY 2023, as well as providing an incentive for ACOs to report eCQM/MIPS CQM measures in performance years 2022 and 2023.

For performance year 2022, if an ACO reports:

• The 10 CMS Web Interface measures and achieves a quality performance score equivalent to or higher than the 30th percentile across all MIPS Quality performance category scores, the ACO would meet the quality performance standard used to determine shared savings and losses.
• The 3 eCQM / MIPS CQM measures (meeting data completeness and case minimum requirements) and achieves a quality performance score equivalent to the 30th percentile benchmark on one measure in the APP measure set, the ACO would meet the quality performance standard used to determine shared savings and losses.

For performance year 2023, if an ACO reports:

• The 10 CMS Web Interface measures and at least one eCQM/MIPSCQM measure and achieves a quality performance score equivalent to or higher than the 30th percentile across all MIPS Quality performance category scores, the ACO would meet the quality performance standard used to determine shared savings and losses.

• The 3 eCQMs / MIPS CQM measures (meeting data completeness and case minimum requirements) and achieves a quality performance score equivalent to the 30th percentile benchmark on one measure in the APP measure set, the ACO would meet the quality performance standard used to determine shared savings and losses.

In performance year 2024, the threshold for the quality performance standard will increase to the 40th percentile MIPS Quality performance category score.

Finally, for performance year 2021 and subsequent performance years, CMS confirms that the CAHPS for MIPS minimum sampling thresholds also apply to Shared Savings Program ACOs.

APM Performance Pathway (APP) Proposal

CMS proposes to allow MIPS eligible clinicians to report the APP as a subgroup beginning with the 2023 performance year. The definition of a subgroup and eligibility to participate as a subgroup are the same for MVP and APP reporting.

• Subgroups would consist of “a subset of a group which contains at least one MIPS eligible clinician and is identified by a combination of the group TIN, the subgroup identifier, and each eligible clinician’s NPI.”
• Subgroups would inherit the eligibility and special status determinations of the affiliated group (identified by TIN). To participate as a subgroup, the TIN would have to exceed the low-volume threshold at the group level, and the subgroup would inherit any special statuses held by the group, even if the subgroup composition would not meet the criteria.

MIPS Value Pathways (MVP)

The 2022 QPP Proposed Rule includes information related to the introduction of MIPS Value Pathways (MVPs).  This highly anticipated topic will be covered in an upcoming blog post, coming soon!