CMS proposed several changes to the 2023 MIPS program including: 1) Transitioning clinicians to report through the APP or MVP frameworks by 2027 by sunsetting traditional MIPS reporting. 2) Adding 5 new MVPs for a total of 12 options. 3) Modifying quality measures by removing 15, changing 75 existing ones, and adding 9 new measures. 4) Requiring a 75% data completeness threshold starting in 2024 for quality reporting. 5) Allowing APM entities to report PI data at the entity level rather than individually.

1. CMS 2023
Proposed Rule
01
QUALITY PAYMENT PROGRAM

2. 2
Key things to know
MIPS 2023

3. 3
Remember, these
proposed changes are not
finalized yet.

4. 4
General Proposed
Changes
1

5. General Proposed Changes
In general, CMS stated that they did not make many
changes to the traditional MIPS program in order to
prepare people for transitioning to the other
reporting frameworks.
5

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

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

8. 8
APP
APM Performance Pathway

9. APP Reporting Option
1
WHAT
Remember that 2022 is
the first year you can
report using the APM
Performance Pathways
(APP) program.
9

10. APP Reporting Option
1
WHAT
Remember that 2022 is
the first year you can
report using the APM
Performance Pathways
(APP) program.
10
2
WHO
MSSP ACOs must
report through the
APP.

11. APP Reporting Option
1
WHAT
Remember that 2022 is
the first year you can
report using the APM
Performance Pathways
(APP) program.
11
2
WHO
MSSP ACOs must
report through the
APP.
3
WHEN
Only MSSP ACOs reporting
through APP may continue to
use the CMS Web Interface
measures in 2023 and 2024.
Otherwise, this method of
submission is sunset in 2023.

12. 12
MVP
MIPS Value Pathway

13. MVP Reporting Option
1
WHAT
Remember that 2023 is
the first year you can
report using the MIPS
Value Pathways (MVPs)
program.
13

14. MVP Reporting Option
1
WHAT
Remember that 2023 is
the first year you can
report using the MIPS
Value Pathways (MVPs)
program.
14
2
WHO
CMS added 5 additional
MVPs to the original 7.

15. MVP Reporting Option
15
CMS added 5 additional MVPs to the original 7.
1. Rheumatology
2. Stroke Care & Prevention
3. Heart Disease
4. Chronic Disease Management
5. Emerging Medicine
6. Lower Extremity Joint Repair
7. Anesthesia
1. Advancing Cancer Care
2. Optimal Care for Kidney Health
3. Optimal Care for Patients with Episodic Neurological Conditions
4. Supportive Care for Neurodegenerative Conditions
5. Promoting Wellness
New MVPs
Original MVPs – Modifications Proposed

16. MVP Reporting Option
1
WHAT
Remember that 2023 is
the first year you can
report using the MIPS
Value Pathways (MVPs)
program.
16
2
WHO
CMS added 5 additional
MVPs to the original 7.
3
WHEN
Participants must
register for the MVP
between April 1 and
November 30 of the
performance year.

17. 17
Traditional MIPS
Reporting Changes

18. 18
Performance
Threshold
2

19. PERFORMANCE
THRESHOLD
The performance
threshold will remain:
75 POINTS
19
AVOID
PENALTY
This is based on the
mean average from
previous years.
Eligible Clinicians
need to score at least
75 points to avoid a
penalty in 2023.
BONUS
There is no longer
an Exceptional
Performance
Bonus.

20. 20
Minimum
Scores By Year

21. 21
2023 Performance Threshold

22. 22
Penalties &
Incentives

23. 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. 24
Category Weights
3
NO CHANGES

25. 25
Category Requirements
4
MODIFICATIONS TO THE

26. CATEGORY
WEIGHT
30%
PERFORMANCE
PERIOD
365 DAYS
26
QUALITY CATEGORY

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

28. Quality Category
At that time all MSSP ACOs will need to report APP using
eCQMs for all patients, all providers across all practices
for 365 days of the year.
28

29. Quality Category
29
Measure Adjustments
• Removing 15 quality measures
• 2 more measures partially removed (retained for MVP)
• Significantly change 75 existing MIPS quality measures
• Add 9 new quality measures

30. Quality Category
30
Data Completeness
• CMS is proposing to move the data completeness threshold
from 70% (current state) to 75% starting in 2024.

31. CATEGORY
WEIGHT
30%
PERFORMANCE
PERIOD
365 DAYS
31
COST CATEGORY

32. Cost Category
Starting with 2022 Reporting
CMS is proposing to have a maximum of 1 bonus point for
Cost improvement over previous reporting period
32

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

34. Improvement Activities Category
CMS is proposing some measure changes in this category:
• Add 4 new Improvement Activities (IA) measures
• Modify 5 IA measures
• Remove 6 IA measures
34

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

36. PI Category
36
Measure Adjustments
• Query of Prescription Drug Monitoring Program (PDMP) REQUIRED
in 2023.
• This would be worth 10 points
• Expand the scope of the measure to include not only Schedule
II opioids but also Schedules II and IV drugs.

37. PI Category
37
Measure Adjustments
• And there’s a 3rd option to satisfy the HIE objective requirement.
You can:
• Option 3: Participate in the Trusted Exchange Framework and
Common Agreement (TEFCA)

38. PI Category
38
Measure Adjustments
Because of these two
changes the measures
are scored differently.
Objective Measure
Max
Points
Electronic Prescribing
e-Prescribing 10 points
Query of PDMP 10 points
HIE
Support Electronic Referral Loops by Sending Health
Information
15 points
Support Electronic Referral Loops by Receiving Health
Information
15 points
- OR -
Health Information Exchange Bi-Directional Exchange 30 points
- OR -
Participation in TEFCA 30 points
Provider to Patient
Exchange
Provide Patients Electronic Access to Their Health Information 25 points
Public Health and Clinical
Data Exchange
Report the following 2 measures:
• Immunization Registry Reporting
• Electronic Case Reporting
25 points
Report one of the following measures:
• Syndromic Surveillance Reporting
• Public Health Registry Reporting
• Clinical Data Registry Reporting
5 points
(bonus)

39. PI Category
39
Measure Adjustments
• CMS is proposing to allow an APM Entity to report PI data at the
APM Entity level rather than requiring individual or group level
reporting of PI data.

40. PI Category
40
Scoring
• For some Eligible Clinicians, CMS automatically reweights this
category to 0 points and adds that percentage weight to their
quality score.
• CMS proposes to remove these titles from that reweighting:
• Nurse practitioners
• Physician assistants
• Certified registered nurse anesthetists
• Clinical nurse specialists

41. 41
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