The Merit-based Incentive Payment System (MIPS) will remain much the same as it is in 2025 to a) facilitate a transition to MIPS Value Pathways (MVPs) and b) accommodate a smooth re-entry for clinicians who have filed for exemptions due to Extreme and Uncontrollable Circumstances (EUC). MVPs will likely be the next “landing spot” for MIPS with fewer choices and more competition defining the future of the Quality Payment Program.
There will be continued emphasis on data extraction for reporting as evidenced by Fast Healthcare Interoperability Resources (FHIR), a standard developed by HL7 for exchanging healthcare information electronically. Patient outcomes will remain a focus and efforts are underway to a) compare “like” specialty to “like” specialty and b) include as many clinicians in the program as possible.
Quality Measure Deletions
- #185: Colonoscopy Interval for Patients with a History of Adenomatous Polyps
- #264: Sentinel Lymph Node Biopsy for Invasive Breast Cancer
- #290: Assessment of Mood Disorders and Psychosis for Patients with Parkinson’s
- #322: Cardiac Stress Imaging Not Meeting Appropriate Use Criteria (standard of care (Radiology)
- #419: Overuse of Imaging for the Evaluation of Primary Headache
- #424: Perioperative Temperature Management (standard of care) (Anesthesia)
- #443: Non-Recommended Cervical Cancer Screening in Adolescent Females
- #487: Screening for Social Drivers of Health (process no longer priority area) (Radiology)
- #498: Connection to Community Service Provider
- #508: Adult COVID-19 Vaccination Status
Quality Measure Changes
- #47: Advanced Care Plan – Did not remove Medicare Part B Claims Reporting (no gap). MIPSCQM
remains (no impact to you). May be “topped out”. - #130: Documentation of Current Medications in the Medical Record – Change only applies to eCQM
version (from EHR); updated code set list for exception. Replace existing “medical reason” value set for
the denominator exception with a new value set (“Acute Health Crisis Direct Reference Code”) for eCQM
collection type. - #357: Surgical Site Infection – Clarifies how to assign performance on an SSI associated with multiple
procedures on single encounter. - #420: Varicose Vein Treatment with Saphenous Ablation: Outcome Survey – Assessment period changed from 3-6 months to now read “up to 6 months” after procedure. Can assess earlier and receive credit.
Note: CMS has revalued certain topped out measures to 10 points, whether reporting through MVPs or traditional MIPS.
Topped Out Quality Measures with 10-Point Benchmarks
Radiology
- #360: Optimizing Patient Exposure to Ionizing Radiation: Count of Potential High Dose Radiation Imaging
Studies: Computed Tomography (CT) & Cardiac Nuclear Medicine Studies - #364: Optimizing Patient Exposure to Ionizing Radiation: Appropriateness: Follow-up CT Imaging for
Incidentally Detected Pulmonary Nodules According to Recommended Guidelines - #405: Appropriate Follow-up Imaging for Incidental Abdominal Lesions
- #406: Appropriate Follow-up Imaging for Incidental Thyroid Nodules in Patients
Pathology
- #249: Barrett’s Esophagus
- #395: Lung Cancer Reporting (Biopsy/Cytology Specimens)
- #396: Lung Cancer Reporting (Resection Specimens)
- #397: Melanoma Reporting
- #440: Skin Cancer: Biopsy Reporting Time – Pathologist to Clinician
- #250: Radical Prostatectomy Pathology Reporting
Anesthesiology
- #430: Prevention of Post-Operative Nausea and Vomiting (PONV) – Combination Therapy
- #463: Prevention of Post-Operative Vomiting (POV) – Combination Therapy (Pediatrics)
- #477: Multimodal Pain Management
Improvement Activities
Additions (3):
- Improving Detection of Cognitive Impairment in Primary Care
- Integrating Oral Health Care in Primary Care
- Patient Safety in Use of Artificial Intelligence (AI): Track attributable bad events, identify cause,
document plan for future mitigation
Changes (1 substantial & 6 minor):
- IA_BMH_1: Diabetes Screening –Antipsychotic drug monitoring: expanding beyond Diabetes screening
to full health screening - Moving 6 existing activities to new subcategory of Advancing Health and Wellness (no impact)
Deletions:
- IA_AHE_5: MIPS Eligible Clinician Leadership in Clinical Trials or CBPR
- IA_AHE_8: Create & Implement an Anti-Racism Plan
- IA_AHE_9: Implement Food Insecurity & Nutrition Risk Identification & Treatment Protocols
- IA_AHE_11: Create & Implement a plan to improve care for LGBTQ+ patients
- IA_AHE_12: Practice improvements that engage community resources to address drivers of health
- IA_PM_26: Vaccine achievement for practice staff: COVID-19, Influenza, Hepatitis B
- IA_PM_6: Use of Toolsets or other resources to close health & health care inequities across communities
- IA_ERP_3: COVID-19 clinical data reporting with or without clinical trial
