MIPS Value Pathways Overview
Introduction
Since 2017, CMS has been making incremental changes to the Merit-Based Incentive Program (MIPS). In 2023, a new reporting path, the MIPS Value Pathway (MVP), was launched. The intention behind the new reporting pathway is to make it easier for different specialties to report their data while still improving the quality of care. MVPs will be voluntary for the 2023-2027 performance years, after which MVPs are expected to become mandatory and traditional MIPS is anticipated to sunset.
MVPs are a predetermined subset of quality and interoperability measures, and improvement activities from traditional MIPS, which are designed to streamline the reporting program and reduce the burden on providers. Additionally, CMS MIPS value pathway affiliated specific cost measures to specific MVPs. This was done so providers would know exactly what cost measures they could be scored on based on their Medicare Part B claims. In addition to the elements drawn from traditional MIPS reporting, MVPs also introduce Population Health measures which will be scored 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. It is important to note that beginning in 2026, multispecialty groups (determined by CMS using Medicare Part B Claims) will be required to form subgroups to report MVPs.
MVP Requirements
Clinicians will be required to select four (4) quality measures (1 will need to be an outcome or a high-priority measure) from the list of measures attributed to the MVP. Clinicians will also be able to select the improvement activities from a list of activities associated with the MVP. Cost will be calculated using only the cost 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
*If clinicians do not meet the case minimum for the chosen population health measure, CMS will calculate the other 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.
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