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MIPS Value Pathways Overview

MIPS value pathways
10 Jul

MIPS Value Pathways Overview

Introduction

Since 2017, CMS has been making incremental changes to the Merit-Based Incentive Program (MIPS). In 2023, the MIPS Value Pathway (MVP) was launched to simplify data reporting for different specialties while enhancing the quality of care. MVPs will be voluntary during the 2023-2027 performance years, after which they are expected to become mandatory as traditional MIPS is anticipated to sunset.

MIPS value pathways

MVPs are a predetermined subset of quality and interoperability measures and improvement activities from traditional MIPS, designed to streamline the reporting program and reduce the burden on providers. Additionally, CMS MIPS value pathway affiliated specific cost measures to specific MVPs. Providers now know exactly which cost measures they can be scored on based on their Medicare Part B claims. In addition to elements from traditional MIPS reporting, MVPs introduce Population Health measures that score based on administrative claims.

MVPs Available To Report As Of 2023

1. Adopting Best Practices and Promoting Patient Safety within Emergency Medicine
2. Advancing Cancer Care
3. Advancing Care Heart Disease
4. Advancing Rheumatology Patient Care
5. Coordinating Stroke Care to Promote Prevention and Cultivate Positive Outcomes
6. Improving Care for Lower Extremity Joint Repair
7. Optional Care for Kidney Health
8. Optimal Care for Patients with Episodic Neurological Conditions
9. Optimizing Chronic Disease Management
10. Promoting Wellness
11. Support Positive Experiences with Anesthesia
12. Supportive Care for Neurodegenerative Conditions

The number of MVPs available will increase as the program expands in the coming years. Beginning in 2026, multispecialty groups determined by CMS using Medicare Part B Claims must form subgroups to report MVPs.

MVP Requirements

Clinicians must select four quality measures, including one outcome or high-priority measure, from the list attributed to the MVP. They can also choose improvement activities from a list associated with the MVP. The system will calculate the cost using only the measures assigned to the MVP through administrative claims data.

Through the MVPs, CMS MIPS value pathway is introducing a new component called the foundational layer. The foundational layer includes two population health measures and the promoting interoperability measures. Clinicians must pick one of the two population health measures available to report, and CMS will score it as part of the quality category. MIPS value pathways have no additional requirements compared to traditional MIPS reporting.

The two population health measures include:
1. Q479: Hospital-Wide, 30-day, All-Cause Unplanned Readmission (HWR) Rate for the MIPS Eligible Clinician Groups
2. Q484: Clinician and Clinician Group Risk-standardized Hospital Readmission Rates for Patients with Multiple Chronic Conditions

*CMS will calculate the other population health measure if clinicians do not meet the case minimum for the chosen population health measure. If neither measure can be applied to the clinician, it will be reweighted.

Scoring
MVP scoring aligns with traditional MIPS scoring. Similar to traditional MIPS, clinicians are able to submit more than the required measures and the four (4) highest will be used in the final score. Clinicians will still need to meet 70% data completeness and reach a 75% threshold to pass in 2023.

*CMS will be raising data completeness to 75% in 2024 and 2025.

MVP Example
Below MIPS value pathway is recommended for the Oncology and Hematology specialties.

Advancing Cancer Care MVP
QUALITY IMPROVEMENT ACTIVITIES COST
(HP)Q47: Advance Care Plan (Collection Type: Part B Claims, MIPS CQM) IA_BE_4: Engagement of Patients through Implementation of Improvements in Patient Portal (Medium) Total Per Capita Cost (TPCC)
Q134: Preventative Care and Screening: Screening for Depression and Follow-Up Plan (Collection Type: Part B Claims, eCQM, MIPS CQM) IA_BE_6: Regularly Assess Patient Experience of Care and Follow Up on Findings (High)
(HP)Q143: Oncology: Medical and Radiation – Pain Intensity Quantified (Collection Type: eCQM, MIPS CQM) IA_BE_15: Engagement of Patients, Family and Caregivers in Developing a Plan of Care (Medium)
(HP)Q144: Oncology: Medical Radiation – Plan of Care (Collection Type: MIPS CQM) IA_BE_24: Financial Navigation Program (Medium)
(HP)Q321: CAHPS for MIPS Clinician/Group Survey (Collection Type: CAHPS Survey Vendor) IA_CC_1: Implementation of Use of Specialist Reports Back to Referring Clinician or Group to Close Referral Loop (Medium)
(HP)Q450: Appropriate Treatment for Patients with Stage I (T1c) – III HER2 Positive Breast Cancer (Collection Type: MIPS CQM) IA_CC_17: Patient Navigator Program (High)
Q451: RAS (KRAS and NRAS) Gene Mutation Testing Performed for Patients with Metastatic Colorectal Cancer who Receive Anti-Epidermal Growth Factor Receptor (EGFR) Monoclonal Antibody Therapy (Collection Type: MIPS CQM) IA_EPA_1: Provide 24/7 Access to MIPS Eligible Clinicians or Groups Who Have Rela-Time Access to Patient’s Medical Record (High)
(HP)Q452: Patients with Metastatic Colorectal Cancer and RAS (KRAS and NRAS) Gene Mutation Spared Treatment with Anti-Epidermal Growth Factor Receptor (EGFR) Monoclonal Antibodies (Collection Type: MIPS CQM) IA_PCMH: Electronic Submission of Patient Centered Medical Home Accreditation
(HP)Q453: Percentage of Patients Who Died from Cancer Receiving Chemotherapy in the Last 14 Days of Life (lower score – better) (Collection Type: MIPS CQM) IA_PM_14: Implementation of Methodologies for Improvements in Longitudinal Care Management for High-Risk Patients (Medium)
(O)Q457: Percentage of Patients Who Died from Cancer Admitted to Hospice for Less than 3 days (lower score – better) (Collection Type: MIPS CQM) IA_PM_15: Implementation of Episodic Care Management Practice Improvements (Medium)
Q462: Bone Density Evaluation for Patients with Prostate Cancer and Receiving Androgen Deprivation Therapy (eCQM) IA_PM_16: Implementation of Medication Management Practice Improvements (Medium)
(HP)PIMSH2: Oncology: Utilization of GCSF in Metastatic Colorectal Cancer (Collection Type: QCDR) IA_PM_21: Advance Care Planning (Medium)
IA_PSPA_16: Use of Decision Support and Standardized Treatment Protocols (Medium)

* TPCC measure which will be the only cost measure that the clinician can be scored on.

 

FOUNDATIONAL LAYER
POPULATION HEALTH MEASURES PROMOTING INTEROPERABILITY
(O)Q479: Hospital-Wide, 30-Day, All-Cause Unplanned Readmission (HWR) Rate for the Merit-Based Incentive Payment System (MIPS) Groups (Collection Type: Administrative Claims) PI attestations and measures are the same as traditional MIPS.
(O)Q484: Clinician and Clinician Group Risk-Standardized Hospital Admission Rates for Patients with Multiple Chronic Conditions (Collection Type: Administrative Claims)

 

*Medicare Part B claims measures are only available to small practices with fifteen or fewer clinicians.