The Centers for Medicare and Medicaid Services (CMS) issued their Final Rule for the 2022 Medicare Physician Fee Schedule (PFS) on November 2, 2021 and it includes changes to the Quality Payment Program (QPP). CMS made some significant revisions to the current MIPS program and continues to lay the foundation for MIPS Value Pathways (MVPs) and the migration of Clinical Quality Measures to FHIRⓇ. Since we are quality measure experts, we will focus on Quality reporting requirements for 2022.
Category Weighting and Performance Thresholds
As mandated in the MACRA legislation, the Quality and Cost performance categories are weighted equally at 30% starting in 2022. Also, the performance threshold has increased. To avoid a penalty, you must score at least 75 points. Non-participation or a low score can result in a 9% penalty on Medicare reimbursement. To qualify for Exceptional Performance and receive up to a 9% bonus, you must score at least 89 points.
Note that the weightings for Promoting Interoperability (PI) and Improvement Activities (IA) have not changed from 2021.
Quality Measure Reporting
For 2022, bonus points are no longer available for end-to-end reporting, high-priority measures or outcomes-based measures. CMS did decide to extend availability of the CMS Web Interface for MIPS Alternative Payment Model (APM) participants. Also, there were some Clinical Quality Measure (CQM) changes.
In the 2021 reporting year, 209 CQMs were available. For 2020, there will be 200 CQMs to choose from, as some old measures were removed and some new ones added:
Intravesical Bacillus-Calmette Guerin for Non-muscle Invasive Bladder Cancer
Hemodialysis Vascular Access: Practitioner Level Long-term Catheter Rate
Person-Centered Primary Care Measure Patient-Reported Outcome Performance Measure (PCPCM PRO-PM)
No eCQMs were removed but CMS did remove some claims-based measures:
Age-Related Macular Degeneration (AMD): Dilated Macular Examination for Medicare Part B Claims type only
Perioperative Care: Selection of Prophylactic Antibiotic – First OR Second-Generation Cephalosporin
Perioperative Care: Venous Thromboembolism (VTE) Prophylaxis (When Indicated in ALL Patients)
Coronary Artery Bypass Graft (CABG): Preoperative Beta-Blocker in Patients with Isolated CABG Surgery
Urinary Incontinence: Plan of Care for Urinary Incontinence in Women Aged 65 Years and Older for Medicare Part B Claims type only
Hematology: Myelodysplastic Syndrome (MDS) and Acute Leukemias: Baseline Cytogenetic Testing Performed on Bone Marrow