It’s possible that you’ve heard that the Merit-based Incentive Payment System (MIPS), also referred to as “Traditional MIPS,” would be phased out completely by the year 2027.

Traditional MIPS will be phased out and replaced with two new programs called “Pathways” by the Centers for Medicare and Medicaid Services (CMS), and in 2022, the present Traditional MIPS program will undergo significant revisions in advance of this transition. Keep an eye out over the next few weeks for additional blog articles that will outline the efforts that CMS is making to consistently improve the value and quality of patient care through the implementation of the MIPS Value Pathways (MVPs) and the Alternative Payment Model Performance Pathway (APP).

You will become more familiar with the alterations that will be made to Traditional MIPS 2022 and more prepared for the impending transition to MVPs as a result of reading this article.

Changes made to the reporting requirements for the traditional MIPS

Traditional MIPS is the initial framework that currently remains available to MIPS-eligible providers for the purpose of obtaining and reporting performance data measures across four areas. It was established in the first year of the Centers for Medicare and Medicaid’s (CMS) Quality Payment Program (QPP).

Quality Enhancement Activities That Are Focused on Promoting Interoperability (PI)
Clinicians who are qualified for the Cost MIPS program will be able to utilize the Traditional MIPS framework until either they want to use the new APP (which will be available in 2022) or they are obliged to use the new MVP framework (available beginning in 2023).

General changes

Clinicians who fall into one of these two new categories are now considered to be eligible for MIPS:

  • Professionals in clinical social work
  • Midwives who have received their certification as nurses
  • Why focusing on this is essential:

These additions were recommended by CMS in order to conform with the definition of eligible clinicians found in the Alternative Payment Model (APM). A participant in an alternative payment model (APM) who is eligible to participate in the Quality Payments Program (QPP) through the Merit-based Incentive Payment System (MIPS) or in another CMS program that uses electronic clinical quality measures (eCQMs) for quality reporting is an eligible clinician (EC).
In the event that your practice employs clinical social workers and/or certified nurse-midwives as providers, those individuals will be required to develop new provider workflows in order to capture the relevant data items that are mandated by MIPS. You will be able to begin MIPS reporting for these new provider types using the electronic health record (EHR) system that is provided by Practice Fusion.

CONSIDERATIONS for the MIPS Program for Clinical Social Workers

Although clinical social workers were not required to report on MIPS in the 2020 and 2021 PPs, CMS did introduce a finalized Clinical Social Work MIPS Specialty Measure Set for 2021 in order to assist these providers in preparing for the time when they would be added to the listing of MIPS-eligible clinicians in future rule-making, which would be for the performance year 2022. This was done in order to ensure that clinical social workers would be able to participate in the MIPS program.

In the Social Work MIPS Specialty, what are the precise quality measures that are being measured?

Measure Set? At the beginning of 2022, CMS is anticipated to complete the finalization of the approved Quality Measures for the Social Work Specialty Measure Set. As a result of this, some of the measures that are approved for 2022 might have some minor distinctions from those that are finalized for 2021. The following components are included in the finalized 2021 Measure Set:

Two Quality measures, out of the original set of Quality measures were required:
Documentation in the Medical Record of Any Currently Being Taken Medication
Care and Screening for Preventable Illnesses: Interventions for Quitting Smoking and Screening for Tobacco Use
Several Quality measures that are particularly specific to the Social Work Specialty, such as the following (although this is not an all-inclusive list):
Care and Screening for Preventable Illnesses: screening for depression and a plan for further evaluation and treatment
Elder Maltreatment Display and a Strategy for Further Action
Dementia: Cognitive Assessment
Evaluation of Functional Capacity in Patients with Dementia
Education and assistance for caregivers of dementia patients who have the condition Dementia
Depression Complete Healing After One Year (outcome measure)
Those diagnosed with schizophrenia should take their antipsychotic medication as prescribed (intermediate outcomes measures)
You may view a complete listing of all of the Quality measures that are included in the Social Work MIPS Specialty Measure Set as well as the data requirements for each one by clicking here.

REQUIREMENTS For Promoting Interoperability and Clinical Social Workers Under the MIPS Program

As was said before, satisfying the requirements of MIPS encompasses a total of four distinct categories, one of which is known as the Promoting Interoperability (PI) category. Clinical social workers may be eligible to have CMS automatically reweight their PI score to zero and distribute their total MIPS scoring according to the following, as described by CMS.

Increases in quality from 30 to 40 percent.
The price will not change from 30%
Enhancement and Change Activities: Increases ranging from 15 to 30 percent
Automatic reweighting is also provided for clinicians who belong to small practices, which are defined as those with 15 or fewer MIPS-eligible clinicians who bill under the practice’s Tax ID Number. Large practices are defined as those with more than 100 MIPS-eligible clinicians who bill under the practice’s Tax ID Number (TIN).
Certified nurse-midwives, also known as certified nurse-midwives (CNMs), are advanced practice registered nurses (APRNs) who also hold midwifery certifications. They are able to administer drugs and have greater clinical responsibilities than registered nurses because they are advanced practice registered nurses (RNs).

The Centers for Medicare and Medicaid Services (CMS) does not at this time offer a Clinical Quality Measure Set for CNMs. As a result, they are required to submit six individual quality measures selected from the list of Clinical Quality Measures (CQMs), which includes general quality metrics as well as any accessible measures related to the specialty in which they work. In contrast to professional social workers, certified nurse midwives are not permitted to reset their PI scores to zero.

Variations in the MIPS score taken as a whole

By category: The QPP program is required by law to equally weigh the Quality and Cost categories at 30% each beginning with the 2022 PP. This requirement applies to the QPP program. The percentages allotted to the PI and Improvement Activity (IA) categories will not change from CY 2021; they will continue to be 25% and 15%, respectively. (As was mentioned previously, there is an exemption granted for clinical social workers and small practices, both of which have their PI categories weighted to zero.)

measurable levels of performance ECs are required to achieve a Minimum Performance Threshold of 75 total MIPS points by the year 2022; this is an increase from the previous threshold of 60 MIPS points, which was established in 2021.

By Williumson

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