2023 Proposed Rule for the Quality Payment Program Released

CMS is removing the three-point floor for measures that can be reliably scored against a benchmark (meet case minimum and data completeness). These measures will receive 1–10 points.
This policy doesn’t apply to new measures in the first two performance periods available for reporting.

For measures without an available benchmark (historical or performance period):

CMS is removing the three-point floor for measures without a benchmark, even when data completeness and case minimum criteria are met. These measures will receive zero points. Small practices will continue to earn three points.
This policy doesn’t apply to new measures in the first two performance periods available for reporting or to administrative claims measures.

For measures that don’t meet case minimum:

CMS is removing the three-point floor for measures that don’t meet case minimum. These measures will earn zero points. Small practices will continue to earn three points.
This policy doesn’t apply to new measures in the first two performance periods available for reporting or to administrative claims measures. Measures calculated from administrative claims are excluded from scoring if the case minimum is not met.

The CMS proposes to:

Discontinue automatic reweighting for the following clinician types: nurse practitioners, physician assistants, certified registered nurse anesthetists and clinical nurse specialists;
Continue automatic reweighting for the following clinician types: clinical social workers, physical therapists, occupational therapists, qualified speech-language pathologists, qualified audiologists, clinical psychologists and registered dieticians or nutrition professionals;
Modify the levels of active engagement for the Public Health and Clinical Data Exchange Objective measures;
Make the query of Prescription Drug Monitoring Program (PDMP) measure a required measure;
Add a third option for satisfying the health information exchange (HIE) objective in the Promoting Interoperability category: Participation in the Trusted Exchange Framework and Common Agreement (TEFCA); and
Adjust some of the individual Promoting Interoperability measures’ maximum points.

The CMS is proposing to update the improvement activities inventory by:

Adding four new improvement activities;
Modifying five existing improvement activities; and
Removing six improvement activities.
- Note that one activity proposed for removal—IA_PSPA_6: Consultation of the Prescription Drug Monitoring Program—has been a popularly submitted improvement activity through the RISE registry.

The CMS proposes:

Minor updates to the Advancing Rheumatology Patient Care MVP;
To broaden the opportunities for the public to provide feedback by posting draft versions of MVP candidates on the QPP website; and
Adding five new MVPs and revising the seven previously established MVPs that would be available beginning with the 2023 performance year.

The following policies were previously finalized in the CY 2022 PFS Final Rule and apply in the 2023 performance period:

2023 Medicare Physician Fee Schedule Final Rule for Quality Payment Program Published