Understanding the MIPS Quality Category in 2023

There are numerous changes in the MIPS Quality Category for the 2023 Performance Year. This page will outline the most critical changes for MIPS participants to be aware of in 2023 and a few future rule changes you’ll need to have on your radar.

A general summary may be helpful before we start: there will be 198 MIPS Quality Category measures in 2023, with a handful of changes to some existing measures, eleven measures removed, and nine measures added. There are also changes to the 3-point scoring floor for Quality measures, and the definition of “high priority measure” has been expanded to include health equity related Quality Measures.

Here’s a quick reminder before diving into the changes for 2023: the Quality category will continue to represent 30% of your Final MIPS score.

Data Completeness: No Change in 2023, but an Increase in the Following Year

For the 2023 Performance Year, the Data Completeness threshold will remain at 70%. For an in-depth explanation of current Data Completeness rules with helpful examples, click here >>

Starting in Performance Year 2024, however, the Data Completeness threshold will increase to 75%. Your organization should start preparing today for this rule change. While 5% isn’t a huge increase, you’ll need to ensure you have the proper systems and workflows to capture the necessary data and meet Data Completeness requirements.

The Performance Threshold Will Stay at 75 Until 2025, at Least

For the 2023 Performance Year, the Performance Threshold will stay at 75 points. This, of course, means that MIPS isn’t getting any easier overall.

While the program is challenging, you can still find success, and we’re happy to help. Speak with a Mingle Health expert today about your organization’s specific challenges and opportunities.

MIPS Quality Category Measures: Changes, Additions, and Removals

CMS has changed seventy-six Quality measures in the 2023 Final Rule. There have also been nine Quality measures added and eleven measures removed.

Two removals are essential to note:

Measures 110 and 111 have both been removed from the Traditional MIPS Quality category for the 2023 Performance Year.

• The removal of these measures – both regarding vaccination and immunization statuses – will likely have a sizable impact on MIPS participants in the coming year.
• Your organization may have relied on these measures in past Performance Years – when planning your MIPS strategy for 2023, you’ll need to take this into consideration.

A New, Expanded Definition of “High Priority Measure”

CMS has also expanded the definition of “High Priority” in Quality Measures. In 2023, the definition of “high priority measure” will also include health equity related measures.

In this section of the 2023 Final Rule, CMS states:

“As significant and persistent inequities in healthcare outcomes exist in the United States, we are committed to developing innovative solutions that support access to high quality care and promote health equity, including the exploration of solutions to measure health equity within MIPS.”

With this rationale in mind, CMS has amended the definition of “high priority measure” beginning in 2023; a high priority measure is defined as:

“…an outcome (including intermediate-outcome and patient-reported outcome), appropriate use, patient safety, efficiency, patient experience, care coordination, opioid, or health equity-related quality measure.”

Removal of the 3-Point Floor in Most Instances

CMS has removed the 3-point floor for scoring quality measures in most instances. The 3-point floor remains in place if you’re a small practice or if the measure you’re reporting is new (less than two years old).

In all other cases, the 3-point floor has been removed. You can now score zero points for measures without a benchmark (historic or performance period benchmarks) and measures not meeting case minimums.

You can score anywhere from one to ten points for measures with benchmarks and meeting case minimums.

Benchmarking for Administrative Claims Measures

CMS has also changed the benchmarking rules for Administrative Claims measures. Beginning in 2023, all administrative claims measures will be scored exclusively against Performance Period Benchmarks.

A reminder of how Performance Period Benchmarks work may be helpful here:

• For Historic Benchmarks, submitted measures are scored against past performance from MIPS participants.
  • The benchmark is based on historical data – meaning there’s a reasonable amount of predictability in how the measure will be scored.
• Performance Year Benchmarks are different because CMS will set benchmarks for a measure using data from the same performance year.
  • MIPS participants across the country will submit data; then CMS will use that year’s data to set the benchmarks for the year.
  • This change to Administrative Claims measures in the 2023 Final Rule means that MIPS participants will only have insight into benchmarks and scoring for these measures after all data is submitted.

Mingle Health is here to help.

Have additional questions or concerns about the MIPS Quality Category in 2023? Get in touch with one of our experts today to learn more about MIPS, understand how you can improve your organization’s performance, and set yourself up for success in the coming years.

Click here to return to the 2023 MIPS Success Guide >>