2022 Proposed Rule for the Quality Payment Program Released

On July 13, 2021, the Centers for Medicare & Medicaid Services (CMS) released the proposed rule for the 2022 performance year of the Quality Payment Program (QPP) via the Medicare Physician Fee Schedule (PFS) Notice of Proposed Rulemaking (NPRM). ACR RISE registry staff have highlighted key proposed policies for the 2022 traditional Merit-Based Incentive Payment System (MIPS) reporting period and changes from the 2021 MIPS reporting period.

The proposed changes to performance category weighting and performance thresholds are in line with MACRA legislation requirements for the 2022 performance year. The CMS continues to refine measures and score calculations for each category. Included in this proposed rule are details for MIPS Value Pathway (MVP) scoring and the first list of approved MVPs for the 2023 performance year, including a rheumatology MVP submitted by the ACR. Notably, the CMS also proposes to end the current MIPS program in favor of MVP and APM participation after the 2027 MIPS performance year.

Details of the proposed rule are listed below.  If you have questions or concerns about how these proposed changes may affect your practice, contact RISE staff at RISE@rheumatology.org. The ACR will also be commenting on the full proposed rule ahead of the comment deadline this September.

The proposed changes are not finalized until the CMS announces the final rule, expected in November. The ACR will review and evaluate the final rule once announced and will provide more information at that time on the impact for practices.

MIPS-Eligible Clinician Types
The CMS is proposing to add clinical social workers and certified nurse midwives as MIPS-eligible clinician types beginning with the 2022 performance year.

Performance Category Weights

• Quality: 30% for CY 2022 (40% for CY 2021)
• Cost: 30% for CY 2022 (20% for CY 2021)
• Promoting Interoperability: 25% (no change from CY 2021)
• Improvement Activities: 15% (no change from CY 2021)

Performance Thresholds

• Performance threshold at 75 points (60 points for CY 2021)
• 89 points for exceptional performance (85 points for CY 2021)
  • Note: CY 2022 is the last year to earn the additional performance threshold and the associated additional MIPS payment adjustment factors for exceptional performance.

Quality Performance Category
The CMS is proposing to:

• Update quality measure scoring to remove end-to-end electronic reporting and high priority measure bonus points, and remove the 3-point floor for scoring measures (excepting new measures);
• Use performance period benchmarks for a different baseline period, such as CY 2019, for scoring quality measures in the 2022 performance period (assessing 2020 data currently);
• Extend the CMS Web Interface as a quality reporting option for registered groups, virtual groups, or other APM Entities for the 2022 performance period;
• Update the quality measure inventory; and
• Maintain the current data completeness threshold at 70% for the 2022 performance period and increase the data completeness requirement to 80% beginning with the 2023 performance period.

Promoting Interoperability Performance Category
The CMS is proposing to:

• Apply automatic reweighting to clinical social workers and small practices;
• Revise reporting requirements for the Public Health and Clinical Data Exchange objective to require MIPS-eligible clinicians to report the following two measures: Immunization Registry Reporting and Electronic Case Reporting;
• Add a requirement in the Provide Patients Electronic Access to Their Health Information measure that patients have access to their health information indefinitely for encounters on or after Jan. 1, 2016;
• Require MIPS-eligible clinicians to attest to conducting an annual assessment of the High-Priority Guide of the Safety Assurance Factors for EHR Resilience Guides (SAFER Guides) beginning with the CY 2022 performance period; and
• Modify the Prevention of Information Blocking attestation statements to distinguish this from separate information blocking policies under the Office of the National Coordinator for Health Information Technology (ONC) requirements established in the 21st Century Cures Act final rule.

Improvement Activities Performance Category
The CMS is proposing to update the improvement activities inventory by:

• Adding 7 new improvement activities;
• Modifying 15 current improvement activities; and
• Removing 6 improvement activities.

Cost Performance Category
The CMS is proposing to add five new episode-based cost measures:

• 2 procedural measures (melanoma resection, colon and rectal resection);
• 1 acute inpatient measure (sepsis); and
• 2 chronic condition measures (diabetes, asthma/chronic obstructive pulmonary disease [COPD]).

The Future of Traditional MIPS Reporting & MVPs
The CMS proposes to delay the implementation of the new MVPs, originally scheduled for 2022, until the 2023 performance year. The ACR’s rheumatology-focused MVP is included in the approved list. Additionally, the CMS is proposing to end traditional MIPS after the 2027 performance year in favor of MVP and APM participation.

The ACR’s rheumatology-focused MIPS Value Pathway is included in the approved list.

The CMS also proposes creating a “subgroup” concept for future MIPS/MVP reporting. The subgroup category is defined as: “A subset of a group which contains at least one MIPS-eligible clinician and is identified by a combination of the group Taxpayer Identification Number (TIN), the subgroup identifier, and each eligible clinician’s National Provider Identifier (NPI).” Subgroups would first be able to report via MVPs and APMs in the 2023 performance year.

Additional Resources
These are key takeaways from the proposed rule; this is not a comprehensive list of all proposed changes. The ACR will comment on the proposed rule on behalf of the specialty. Members may submit their comments to the ACR Advocacy team or comment to the CMS directly. The 2022 final rule is expected to be released in November 2021. Additional information about the PFS NPRM and the QPP proposals is available here.

Questions?
Contact the Quality Payment Program at 1-866-288-8292 or by email at QPP@cms.hhs.gov.

ACR RISE registry staff are also available to assist you with questions related to reporting for MIPS. Contact the RISE registry at 404-633-3777 or by email at RISE@rheumatology.org.