On July 13, the CMS published its proposed 2024 Quality Payment Program (QPP), which aims to limit changes in traditional Merit-based Incentive Payment System (MIPS) to provide clinicians continuity and consistency while they gain familiarity with their new MIPS Value Pathways (MVPs) and move toward accountable care and advanced alternative payment models. Though limited, the proposed changes to the MIPS program could have a significant impact on pathologists’ scores and payment bonuses.

The CAP has long advocated to make MIPS less burdensome for pathologists and has created measures to increase pathologists’ opportunities to demonstrate the quality they provide and score well in the program.

Proposed 2024 MIPS Reporting for Pathologists

In 2024, pathologists reporting MIPS will have to take action to avoid penalties that reduce future Medicare Part B payments for their services. Failing to reach the scoring threshold in 2024 could result in Medicare payment penalties up to 9% for payments in 2026.

In its proposed 2024 QPP regulations the CMS will:

• Raise the Performance Threshold to 82 points in order to avoid a penalty, which the CAP opposes.
• Raise the data completeness threshold (percentage of cases that need to be reported) to 75% for CY 2024, CY 2025, and CY 2026, then raise the threshold to 80% in CY 2027.
• No measures were removed from the Pathology Specialty Measure Set
• The CMS is continuing its efforts to implement MVPs, although there are no pathology-related MVPs at this time.

The CMS requests information on how to ensure physicians continually improve performance, potentially by increasing reporting requirements and/or requiring reporting on specific measures.

The CAP continues to advocate for pathologists’ success in the MIPS program. With the proposed 2024 increase is performance threshold, it is likely that many small practices –especially those that rely heavily on the topped out QPP measures-- could see a reduction in their MIPS performance scores, and this could lead to penalties. Billing companies alone are not able to avoid this problem for practices. We encourage practices (and their billing companies) to review the scoring changes and contact CAP at mips@cap.org to understand the availability of higher-scoring measures and how to best report them.

Advanced Alternative Payment Models (APMs)

The QPP includes two participation tracks for clinicians providing services under the Medicare program: MIPS and Advanced APMs. If an eligible clinician participates in an Advanced APM and achieves Qualifying APM Participant (QP) or Partial QP status, they are excluded from the MIPS reporting requirements. In this proposed rule, the CMS emphasizes that they remain steadfast in their “commitment to support providers in the transition from traditional MIPS to APMs and Advanced APMs.”

Specifically, the CMS proposes to modify the current CEHRT use criterion for Advanced APMs in order to promote flexibility and emphasize the importance of interoperability and health information technology (HIT). The CAP has previously commented on the unique challenges that pathologists face in meeting many of the typical electronic health record and HIT requirements. The CMS is also proposing to calculate QP determinations at the individual level for each unique national provider identifier (NPI) associated with an eligible clinician participating in an Advanced APM.

In an earlier request for information, the CAP expressed concern about this change, stating that a “transition to solely individual QP determinations will no doubt drive some clinicians out of APMs and increase the complexity of the program for physicians.” Finally, the proposed rule incorporates changes made by the Consolidated Appropriations Act of 2023 and supported by the CAP, including extending the APM Incentive Payment at 3.5% through payment year 2025.