On November 1, the CMS also published its final 2023 Quality Payment Program (QPP) regulation, finalizing changes in the traditional Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs) programs.

For pathologists reporting MIPS in 2023, failing to reach the scoring threshold of 75 points could result in Medicare payment penalties up to 9%, affecting payments in 2025.

CMS Made it Harder to Reach the MIPS Scoring Performance Threshold to Avoid a Penalty

In the final 2023 QPP regulations, although the performance threshold remains at 75 points, the CMS made it harder to reach this score. For example, measures that used to be worth between 3 and 7 points could be worth as little as 1 point in 2023. Because almost all the pathology QPP measures are topped-out, pathologists must achieve a near-perfect score to get 7 points. Otherwise, if a practice fails to achieve a near-perfect score, the practice could receive only 1 point for that measure. Additionally, the exceptional performance bonus pool is no longer available, meaning that payment increases could be lower, and it is to practices’ advantage to score as close to 100% as possible.

In addition, the CMS is removing several Improvement Activities from the program in 2023, including “Leadership engagement in regular guidance and demonstrated commitment for implementing practice improvement changes” (IA_PSPA_20). Many pathology practices have used this and other removed Improvement Activities. The CAP encourages practices to review the list of added and removed Improvement Activities before 2023 begins.

With the final 2023 changes to scoring, it is likely that many practices – especially those that rely heavily on the topped-out QPP measures – will see a reduction in their MIPS performance scores, leading to penalties. Billing companies alone will not be able to avoid this problem for many practices. The CAP continues to advocate for pathologists’ success in the MIPS program.

QPP Measure Updates

The CAP committed resources to successfully provide a new measure for use by any pathologist in the MIPS program - Mismatch Repair (MMR) or Microsatellite Instability (MSI) Biomarker Testing Status in Colorectal Carcinoma, Endometrial, Gastroesophageal, or Small Bowel Carcinoma. This measure was added to the Pathology Specialty Measure set. However, per comments by the CAP, the CMS did not add screening for social determinants of health to the pathology measure set.

Finally, the CMS remains committed to implementing MIPS Value Pathways (MVPs), although there are no pathology-related MVPs at this time. The CAP will continue to monitor development of MVPs to ensure pathologists can successfully participate if necessary and to protect pathologists’ interests as a critical part of the clinical care team.

The CAP has long advocated to make MIPS reporting less burdensome for pathologists created measures to increase their opportunities to demonstrate the quality they provide and score well in the program. We encourage practices (and their billing companies) to review the scoring and Improvement Activity changes and contact CAP at mips@cap.org to understand the availability of higher-scoring measures and how to best report them.

Alternative Payment Models

For those pathologists who practice in an Alternative Payment Model (APM), the final 2023 QPP regulation made minor changes. In particular, the CMS finalized making permanent the generally applicable revenue-based nominal amount standard at 8%, which the CAP supported. Additionally, while the CMS did not make any changes to Advanced APM incentives at this time, they thanked commenters for providing feedback on this topic and stated they would continue monitoring and engaging the issue with the public.

What Will Be the Impact of the Final QPP Regulation on Your Practice?

CAP members can learn more about the final QPP regulations by attending a complimentary webinar on Monday, December 5 at 3 PM ET/ 2 PM CT where experts will review the final 2023 Medicare regulations and their impact on payment for pathology services.

Register today