The 2023 final rule offered plenty to digest, and while we tried to offer readers the most important takeaways from the more-than-3,000 page document in our final rule breakdown, there are a few areas deserving of a deeper dive for those among you who appreciate the nitty-gritty. For providers participating in the Merit-based Incentive Payment System (MIPS), recent changes to the program can have a big impact on how they’ll be scored—and thus paid—in the future. So, we’re opening the final rule once more to bring you the latest developments for MIPS for physical therapy, occupational therapy, and speech-language pathology.
There are slight changes to MIPS scoring.
Maybe the most pressing concern for clinicians is how MIPS scoring is changing, given its impact on future payment adjustments. In the 2023 final rule, CMS laid out the scoring guidelines for the MIPS 2023 performance year/2025 payment year. If your MIPS score falls below 75 points, you’ll see a negative adjustment to your payments, with worse scores earning a greater negative adjustment. Those with Final Score points between 18.76 and 74.99 points will receive a negative payment adjustment somewhere between -9% and 0%, based on a sliding scale.
If your Final Score is above 75 points, you’ll get a positive payment adjustment. Again, better scores earn greater positive adjustments, with those scoring between 76 and 100 points earning somewhere between a 0% and 9% positive adjustment. Unfortunately, positive payment adjustments for exceptional performance are a thing of the past starting in CY 2023, so the highest achievers within MIPS will no longer get any additional payment adjustments.
With the 2023 final rule CMS is also finalizing the removal of the three-point floor for each measure that can be reliably scored against the benchmark; instead, each measure will be scored from one to 10 points starting with the CY 2023 performance period/2025 MIPS payment year. That policy won’t apply to new measures for the first two periods available for reporting.
New quality measures will apply PTs and OTs.
MIPS is adding 22 new quality measures, increasing the overall number of quality measures to 198. Most of the new additions aren’t necessarily applicable to rehab therapists, so we’ve highlighted the new measures you should be aware of:
- Quality Measure 048, Urinary Incontinence: Assessment of Presence or Absence of Urinary Incontinence in Women Aged 65 Years and Older: Percentage of female patients aged 65 years and older who were assessed for the presence or absence of urinary incontinence within 12 months.
- Quality Measure 178, Rheumatoid Arthritis (RA) Functional Status Assessment: Percentage of patients aged 18 years and older with a diagnosis of rheumatoid arthritis (RA) for whom a functional status assessment was performed at least once within 12 months.
- Quality Measure 487, Screening for Social Drivers of Health: Percent of beneficiaries 18 years and older screened for food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety.
Existing quality measures got a few updates.
Similarly, not every change to existing quality measures is noteworthy for rehab therapists. Here are the additions to current quality measures most likely to affect PTs, OTs, and SLPs:
- For Quality Measure 050: Urinary Incontinence: Plan of Care for Urinary Incontinence in Women Aged 65 Years and Older, CMS has added coding for occupational therapy (OT) to support this measure, as it is applicable to the scope of care for OTs.
- CMS finalized their proposal to remove Quality Measure 130: Documentation of Current Medications in the Medical Record from Medicare Part B claims collection type. Instead, CMS is retaining the measure for electronic quality control measures (eCQM) and MIPS quality control measures.
- With Quality Measure 134: Preventive Care and Screening: Screening for Depression and Follow-Up Plan, CMS has added a grace period after an encounter to allow more time for clinicians to document a follow-up plan. They have also added a depression screening for patients who have not previously suffered from depression or bipolar disorder, in addition to clarifying the timing requirements for diagnoses for measure exclusions.
- For Quality Measure 181: Elder Maltreatment Screen and Follow-Up Plan, CMS has revised the measure description and the measure denominator.
- CMS also updated the measure description for Quality Measure 182: Functional Outcome Assessment, as well as the numerator, numerator definition, numerator instructions and numerator options.
- For Quality Measures 217 (Functional Status Change for Patients with Knee Impairments), 218 (Functional Status Change for Patients with Hip Impairments), 219 (Functional Status Change for Patients with Lower Leg, Foot or Ankle Impairments), 220 (Functional Status Change for Patients with Low Back Impairments), 221 (Functional Status Change for Patients with Shoulder Impairments), 222 (Functional Status Change for Patients with Elbow, Wrist or Hand Impairments) and 478 (Functional Status Change for Patients with Neck Impairments), CMS updated the measure definitions to allow clinicians who prefer passive range of motion (PROM) reporting to utilize a crosswalk.
- CMS is allowing a lookback of six months for tobacco cessation prior to the current measurement period for Quality Measure 226: Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention.
- For Quality Measure 431: Preventive Care and Screening: Unhealthy Alcohol Use: Screening and Brief Counseling, CMS updated the denominator exclusion, denominator criteria, numerator definition and numerator options.
Optional MIPS Value Pathways (MVPs) reporting starts in 2023.
Although MIPS Value Pathways reporting begins in CY 2023, the program will remain voluntary through 2027, offering clinicians ample opportunity to recommend changes as CMS presumably irons out potential issues. In the 2023 final rule, CMS announced their plans to accept recommendations on current MVPs beginning in January and running throughout the year. They will also host an annual webinar to provide an opportunity for the public to offer feedback on the recommendations.
For the 2023, 2024, and 2025 calendar years, MVP participants can include:
- Individual clinicians,
- Single specialty groups,
- Multispecialty groups,
- Subgroups, and
- APM entities.
Beginning in 2026, multispecialty subgroups will have to form subgroups for the purposes of MVP reporting.
New MVP categories were added in the final rule.
There’s also new MVP categories being introduced for CY 2023. In the 2022 final rule, CMS finalized seven MVP categories:
- Patient Safety and Support of Positive Experiences with Anesthesia
- Optimizing Chronic Disease Management
- Adopting Best Practices and Promoting Patient Safety with Emergency Medicine
- Advancing Care for Heart Disease
- Improving Care for Lower Extremity Joint Repair
- Advancing Rheumatology Patient Care
- Coordinating Stroke Care to Promote Prevention and Cultivate Positive Outcomes
With the 2023 edition of the final rule, CMS has added an additional five:
- Advancing Cancer Care
- Optimal Care for Kidney Health
- Optimal Care for Patients with Episodic Neurological Conditions
- Supportive Care for Neurodegenerative Conditions
- Promoting Wellness
If you’re interested in learning more about each pathway, check out this resource from QPP.
Data completeness requirements are increasing next year.
At the moment, the standards for MIPS data completeness are holding steady at 70% for CY 2023. However, the data completeness requirements are rising to 75% for CY 2024 and CY 2025 performance periods, which would be the 2026 and 2027 MIPS payment years, respectively.
The Extreme and Uncontrollable Circumstances policy has been updated.
The past two years have brought major disruption to health care, and while things are trending back to normal, the effects of the COVID-19 pandemic are still being seen in how clinicians’ work was negatively affected by circumstances beyond their control. The MIPS automatic Extreme and Uncontrollable Circumstances (EUC) policy was created to aid providers affected by natural disasters or public health emergencies (PHEs). Under the policy, providers can request to have their four performance categories reweighed to 0% and to receive a neutral payment adjustment if they’ve been subject to extreme or uncontrollable circumstances.
For CY 2023, CMS is now accepting applications for the EUC exception through January 2, 2024. It should be noted that CMS is not automatically applying the EUC exception for individual MIPS-eligible clinicians due to COVID-19 for this upcoming performance year, but they will allow clinicians, groups, or virtual groups to “request reweighting of one or more MIPS performance categories due to the COVID-19 PHE.”
There are, however, instances when the EUC will be automatically applied. CMS communicates that information through the QPP listserv (you can sign up for that at the bottom of the QPP website). They will also update this fact sheet to identify new events that have been added to the automatic exemptions list. Currently, CMS identifies the following four regions as FEMA-designated disaster areas that qualify for automatic exceptions:
- Kentucky: DR-4663-KY
- New Mexico: DR-4652-NM
- Puerto Rico: DR-4671-PR
- Florida: EM-3584-FL
For those providers looking to opt out, be sure not to submit any 2023 MIPS data, as that will nullify your exemption, and you will be scored based on the data submitted. If you want to stay up to date on automatic EUC implementations, you can subscribe to the QPP listserv on the QPP website.
There’s probably much that will change with MIPS in the next few years as CMS looks to push, pull, and tweak the program into something that works for providers all across health care. Rest assured, we’ll be ready to pour over all the latest info to keep you in the know on how MIPS is impacting rehab therapists.
