ACR CONVERGENCE 2021—Rheumatologists should start to prepare now for the Centers for Medicare & Medicaid Services (CMS) transition to the Merit-Based Incentive Payment System (MIPS) Value Pathways (MVPs) in 2023, according to presenters at an ACR Convergence session, Business of Rheum: Ahead of the Payment Curve. Angus B. Worthing, MD, FACP, FACR, a partner with Arthritis & Rheumatism Associates, Washington, D.C., moderated the session.
The use of MVPs was first proposed in 2020. The program was slated to begin in the 2022 performance year, but was delayed until 2023 due to questions about implementation and the COVID-19 pandemic, said Kent “Kwas” Huston, MD, a rheumatologist with Kansas City Physician Partners, Kansas City, Mo. With the extra time, he said, “We can all take a breath and figure out how we can fit into it and be successful.”
Changes Under MVPs
According to the CMS, guiding principles are that MVPs:
- Have limited, connected, complementary sets of measures that are meaningful to clinicians;
- Include measures and activities that provide comparative performance data;
- Include measures using the Meaningful Measures approach and a patient voice when possible. “There is a strong interest in patient-reported outcomes over time,” Dr. Huston said;
- Reduce barriers to Alternative Payment Model (APM) participation by including measures that are part of APMs when feasible and by linking cost and quality measurement; and
- Support the transition to digital quality measurement.
Rheumatology has the advantage of being one of only seven areas with proposed MVPs in the 2023 pilot, said William F. Harvey, MD, MSc, FACR, clinical director of the Arthritis Treatment Center and chief informatics medical officer at Tufts Medical Center, Boston. The rheumatology MVP is under the category of Advancing Rheumatology Patient Care. Other proposed MVPs are:
- Coordinating Stroke Care to Promote Prevention and Cultivate Positive Outcomes;
- Advancing Care for Heart Disease;
- Optimizing Chronic Disease Management;
- Adopting Best Practices and Promoting Patient Safety Within Emergency Medicine;
- Improving Care for Lower Extremity Joint Repair; and
- Patient Safety and Support of Positive Experiences Within Anesthesia.
The seven areas will be part of the pilot MVPs in 2023.
Many of the quality measures will focus on things that rheumatologists track already, such as conducting tuberculosis screening before the first course of biologics, periodic assessment of rheumatoid arthritis functional status and safe hydroxychloroquine dosing. Each measure will have a unique code.
Within MVPs, clinicians can focus on a specialty, such as rheumatology, or a specific condition, such as rheumatoid arthritis. The reporting categories under MVPs will be the same as they are under MIPS. However, the number of measures selected in each category will change.
- Quality: Clinicians should report four measures, with at least one outcome or high-quality measure.
- Improvement activities: Clinicians should report two medium-weighted or one high-weighted activity.
- Promoting interoperability: Clinicians should report all measures.
- Cost: This category requires no actual reporting; the CMS will calculate cost based on a variety of claims.
A new layer added to the measures is population health, which involves administration claims measures and no specific data submission, Dr. Harvey said. For now, the two population health measures from which to choose are 1) hospitalwide, 30-day, all-cause, unplanned readmission rate for the MIPS groups; or 2) clinician and clinician group risk-standardized hospital admission rates for patients with multiple chronic conditions. MVP participants will select one population health measure to be added in the quality score.
Dr. Huston also shared how MIPS category weighting will change in 2022. Quality will drop from 40% to 30%; cost will rise from 20% to 30%. Promoting interoperability and improvement activities will remain the same at 25% and 15%, respectively. The performance threshold will increase from 60 to 75 points in 2022.
Readying for Success
Dr. Harvey shared a few questions that rheumatologists can ask themselves to measure their potential success under the proposed MVP:
- Are you tracking performance on the quality measures included in the MVP?
- How well are you performing on those measures?
- Are the improvement activities included in the MVP meaningful and reasonably implemented in your practice?
- Are you an early adapter, or do you prefer to wait for later versions? As with any new experience, there will be bugs to get fixed after the initial launch, Dr. Harvey said.
- Do you have the time and/or ability to report for both MVP and MIPS? From any reporting type, the CMS will use the highest reporting score.
These questions can help show where you may need to make some changes and improvements before starting MVPs, Dr. Harvey said.
Both Dr. Huston and Dr. Harvey emphasized the value of participating in the ACR’s RISE Registry to easily report MVP measures. Rheumatologists can email [email protected] to ask questions, give feedback about MVPs or learn more about RISE participation. There is no extra cost for ACR members to use the RISE registry.
Ultimately, Dr. Huston believes the ACR’s front-end work on developing the rheumatology-specific MVP will help rheumatologists succeed with the new model.
Dr. Harvey encouraged rheumatologists to share feedback on the MVP and, once it is implemented, how it works for practices. These comments can help the ACR advocate with the CMS for improvements.
“New payment models are often big sea changes,” he said. “I’m relieved that this is a more incremental change. The [ability to] step in and test drive is really important for us.”
Vanessa Caceres is a medical writer in Bradenton, Fla.