PFS Proposed Rule 2023

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CMS 2023
Proposed Rule
01
QUALITY PAYMENT PROGRAM

2
Key things to know
MIPS 2023

3
Remember, these
proposed changes are not
finalized yet.

4
General Proposed
Changes
1

General Proposed Changes
In general, CMS stated that they did not make many
changes to the traditional MIPS program in ord...

CMS confirmed they will sunset traditional
MIPS reporting by 2027
which means…
6

7
By 2027, you’ll need to report through either the
APP MVP
Framework
or

8
APP
APM Performance Pathway

APP Reporting Option
1
WHAT
Remember that 2022 is
the first year you can
report using the APM
Performance Pathways
(APP) p...

APP Reporting Option
1
WHAT
Remember that 2022 is
the first year you can
report using the APM
Performance Pathways
(APP) p...

APP Reporting Option
1
WHAT
Remember that 2022 is
the first year you can
report using the APM
Performance Pathways
(APP) p...

12
MVP
MIPS Value Pathway

MVP Reporting Option
1
WHAT
Remember that 2023 is
the first year you can
report using the MIPS
Value Pathways (MVPs)
progr...

MVP Reporting Option
1
WHAT
Remember that 2023 is
the first year you can
report using the MIPS
Value Pathways (MVPs)
progr...

MVP Reporting Option
15
CMS added 5 additional MVPs to the original 7.
1. Rheumatology
2. Stroke Care & Prevention
3. Hear...

MVP Reporting Option
1
WHAT
Remember that 2023 is
the first year you can
report using the MIPS
Value Pathways (MVPs)
progr...

17
Traditional MIPS
Reporting Changes

18
Performance
Threshold
2

PERFORMANCE
THRESHOLD
The performance
threshold will remain:
75 POINTS
19
AVOID
PENALTY
This is based on the
mean average ...

20
Minimum
Scores By Year

21
2023 Performance Threshold

22
Penalties &
Incentives

23
WHAT CAN
YOU LOSE,
WHAT CAN
YOU GAIN?
-9%-0%
For not meeting the
minimum score (75)
< 9%
For the top performers (75.1)

24
Category Weights
3
NO CHANGES

25
Category Requirements
4
MODIFICATIONS TO THE

CATEGORY
WEIGHT
30%
PERFORMANCE
PERIOD
365 DAYS
26
QUALITY CATEGORY

Quality Category
Remember that the CMS Web Interface Submission
Option goes away in 2025
27

Quality Category
At that time all MSSP ACOs will need to report APP using
eCQMs for all patients, all providers across all...

Quality Category
29
Measure Adjustments
• Removing 15 quality measures
• 2 more measures partially removed (retained for M...

Quality Category
30
Data Completeness
• CMS is proposing to move the data completeness threshold
from 70% (current state) ...

CATEGORY
WEIGHT
30%
PERFORMANCE
PERIOD
365 DAYS
31
COST CATEGORY

Cost Category
Starting with 2022 Reporting
CMS is proposing to have a maximum of 1 bonus point for
Cost improvement over p...

CATEGORY
WEIGHT
15%
PERFORMANCE
PERIOD
90 DAYS
33
IMPROVEMENT
ACTIVITIES CATEGORY

Improvement Activities Category
CMS is proposing some measure changes in this category:
• Add 4 new Improvement Activities...

CATEGORY
WEIGHT
25%
PERFORMANCE
PERIOD
90 DAYS
35
PROMOTING
INTEROPERABILITY CATEGORY

PI Category
36
Measure Adjustments
• Query of Prescription Drug Monitoring Program (PDMP) REQUIRED
in 2023.
• This would b...

PI Category
37
Measure Adjustments
• And there’s a 3rd option to satisfy the HIE objective requirement.
You can:
• Option ...

PI Category
38
Measure Adjustments
Because of these two
changes the measures
are scored differently.
Objective Measure
Max...

PI Category
39
Measure Adjustments
• CMS is proposing to allow an APM Entity to report PI data at the
APM Entity level rat...

PI Category
40
Scoring
• For some Eligible Clinicians, CMS automatically reweights this
category to 0 points and adds that...

41
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