On November 2, the CMS published its final 2024 Quality Payment Program (QPP) rule, 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 will have a significant impact on participating 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 to score well in the program.

Proposed 2024 MIPS Reporting for Pathologists: CMS Is Making it Harder to Avoid a Penalty

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 final 2024 QPP regulations the CMS will:

• Maintain the scoring performance threshold to avoid a penalty at 75 points for CY 2024. The CAP strongly advocated that CMS should not raise the scoring threshold because of the significant reporting burden on pathologists.
• Raise the data completeness threshold (percentage of all applicable cases that need to be reported) to 75% for CY 2024-2026.
• Maintain the Pathology Specialty Measure Set unchanged.
• Continue its efforts to implement MVPs by finalizing 5 new MVPs, but there are no pathology-related MVPs at this time.

The CAP continues to advocate for Medicare payment reform, reduction of reporting burdens that can lead to burnout, and for pathologists’ overall success in the MIPS program. Due to the high performance threshold in 2024, it is likely that many large 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 final rule, the CMS again emphasized that they remain steadfast in their “commitment to support providers in the transition from traditional MIPS to APMs and Advanced APMs.”

Importantly, after receiving comments expressing concern about the proposal to calculate QP determinations at the individual level, including from the CAP, the CMS decided not to finalize the proposal and will continue to make these determinations at the APM Entity level for the 2024 performance period.

The CAP strongly opposed the proposal, stating that it would "drive some clinicians out of APMs and increase the complexity of the program for physicians." The CAP argued that especially for pathologists, who apply their expertise to the diagnosis and management of a wide variety of medical conditions and thus are integral in any care coordination initiatives, “it is imperative that they are recognized in APMs and not disenfranchised from full participation in the Quality Payment Program.”

The CMS agreed, noting concerns raised by commenters, “especially with respect to specialist participation in Advanced APMs,” and that the changes in incentives and the interactions between them combined with the anticipated statutory increases in QP thresholds, “would create significant uncertainty among specialist communities.” Instead, CMS said they will conduct further consultation and analysis to evaluate the expected impact of these policies on eligible clinicians, especially specialists, participating in Advanced APMs.