The Merit-Based Incentive Payment System (MIPS) is a payment system that rewards health care professionals for providing high-quality, cost-effective care. It's part of the Centers for Medicare & Medicaid Services (CMS) Quality Payment Program (QPP). The QPP was created in response to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The goal of MIPS is to shift the focus of health care from volume to value, encouraging providers to focus on giving their patients the highest quality of care in the most cost-effective manner.
Under MIPS, providers must report on six quality measures: four from the Quality Performance Category, one from the Promoting Interoperability Category, and one from the Cost Category. For the 2023 performance year, CMS has announced changes to the quality measures that providers must report. Let's take a look at what these changes are and how they could affect providers.
Changes to the Quality Performance Category
The Quality Performance Category accounts for 60% of a provider's MIPS score. This category includes four measures that must be reported on, and in 2023, two of the measures will be new. The new measures are:
- Measure #1: Preventive Care and Screening: Influenza Immunization
- Measure #2: Care Coordination: Medication Reconciliation Post-Discharge
The other two quality performance measures that will remain the same from the 2022 performance year are:
- Measure #3: Person and Caregiver-Centered Experience and Outcomes of Care
- Measure #4: Population/Public Health: Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
CMS is also introducing a new bonus measure in the Quality Performance Category. This measure is optional and will not be used to calculate a provider's MIPS score, but it could result in a bonus if the provider meets certain criteria.
Changes to the Promoting Interoperability Category
The Promoting Interoperability Category accounts for 25% of a provider's MIPS score. This category includes one measure that must be reported on, and in 2023, the measure will be new. The new measure is:
- Measure #1: Electronic Prescribing (eRx)
The other measure that was included in the Promoting Interoperability Category in the 2022 performance year was:
- Measure #2: Health Information Exchange (HIE)
This measure will no longer be required in the 2023 performance year.
Changes to the Cost Category
The Cost Category accounts for 15% of a provider's MIPS score. This category includes one measure that must be reported on, and in 2023, the measure will be new. The new measure is:
- Measure #1: Total Per Capita Cost (TPCC) for Medicare Part A and Part B
The other measure that was included in the Cost Category in the 2022 performance year was:
- Measure #2: Medicare Spending Per Beneficiary (MSPB)
This measure will no longer be required in the 2023 performance year.
Conclusion
CMS has announced changes to the quality measures that providers must report for the 2023 performance year under the MIPS Quality Payment Program. Providers should take note of these changes and adjust their reporting accordingly. By understanding the requirements, providers can ensure that they are providing the highest quality of care in the most cost-effective manner, and can be rewarded for their efforts under MIPS.