Healthcare Innovation Solutions (HCIS) has reviewed the changes to this year’s Merit-based Incentive Payment System (MIPS) program which outlines the significant updates for the 2025 performance year. These changes will impact healthcare providers’ reporting requirements and reimbursement structures. Here’s a detailed overview of the key modifications:
1. Increased Performance Thresholds
To avoid penalties and potentially earn incentives, clinicians must meet or exceed the updated performance thresholds for 2025:
- Quality Performance Category: Clinicians are required to submit data for at least six quality measures, including one outcome measure or a high-priority measure if an outcome measure is not applicable.
- Cost Performance Category: The weight of the Cost category in the overall MIPS score has been adjusted, emphasizing the importance of cost-effective care.
- Promoting Interoperability (PI) Performance Category: Clinicians must use certified electronic health record technology (CEHRT) that meets the 2015 Edition Cures Update standards to fulfill PI requirements.
- Improvement Activities (IA) Performance Category: Clinicians need to engage in designated improvement activities, with certain new activities introduced and others modified or removed for 2025.
2. Updates to Quality Measures
CMS has revised the quality measures for the 2025 performance year to better align with current clinical practices and improve patient outcomes:
- New Quality Measures: Seven new quality measures have been added to the MIPS program.
| New Quality Measures | Type |
| #494: Excessive Radiation Dose or Inadequate Image Quality for Diagnostic Computed Tomography (CT) in Adults (Clinician Level)* | eCQM |
| #506 Positive PD-L1Biomarker Expression Test Result Prior to First Line Immune Checkpoint Inhibitor Therapy | MIPS CQM |
| #507 Appropriate Germline Testing for Ovarian Cancer Patients | MIPS CQM |
| #508 Adult COVID-19 Vaccination Status | MIPS CQM |
| #509 Melanoma: Tracking and Evaluation of Recurrence | MIPS CQM |
| #510 First-Year Standardized Waitlist Ratio (FYSWR) | MIPS CQM |
| #511 Percentage of Prevalent Patients Waitlisted (PPPW) and Percentage of Prevalent Patients Waitlisted in Active Status (aPPPW) | MIPS CQM |
- Retired Quality Measures: Ten existing quality measures have been removed from the MIPS program.
| Retired Quality Measures | Type |
| #104: Prostate Cancer: Combination Androgen Deprivation Therapy for High Risk or Very High-Risk Prostate Cancer | MIPS CQM |
| #137 Melanoma: Continuity of Care – Recall System: Oncology: Medical and Radiation – Plan of Care for Pain | MIPS CQM |
| #254 Ultrasound Determination of Pregnancy Location for Pregnant Patients with Abdominal Pain | MIPS CQM |
| #260 Rate of Carotid Endarterectomy (CEA) for Asymptomatic Patients, without Major Complications (Discharged to Home by Post-Operative Day #2) | MIPS CQM |
| #409 Clinical Outcome Post Endovascular Stroke Treatment | MIPS CQM |
| #433 Proportion of Patients Sustaining a Bowel Injury at the time of any Pelvic Organ Prolapse Repair | MIPS CQM |
| #436: Radiation Consideration for Adult CT: Utilization of Dose Lowering Techniques* | MIPS CQM |
| #439 Age-Appropriate Screening Colonoscopy | MIPS CQM |
| #452 Patients with Metastatic Colorectal Cancer and RAS (KRAS or NRAS) Gene Mutation Spared Treatment with Antiepidermal Growth Factor Receptor (EGFR) Monoclonal Antibodies | MIPS CQM |
| #472 Appropriate Use of DXA Scans in Women Under 65 Years Who Do Not Meet the Risk Factor Profile for Osteoporotic Fracture | eCQM |
Clinicians should review these changes carefully to ensure they are reporting the most current and relevant measures.
3. Emphasis on Electronic Clinical Quality Measures (eCQMs)
To enhance data accuracy and streamline reporting, CMS is promoting the adoption of eCQMs. These measures integrate directly with electronic health record (EHR) systems, facilitating real-time tracking and submission. Clinicians are encouraged to ensure their EHR systems are optimized for eCQM reporting to meet MIPS requirements effectively.
4. Adjustments in Cost Category Weighting
The Cost category’s weight in the overall MIPS score has been increased, underscoring the need for clinicians to deliver cost-effective care. This adjustment aims to incentivize the reduction of unnecessary spending while maintaining high-quality patient outcomes. Clinicians should analyze their practice patterns to identify areas where cost efficiencies can be achieved without compromising care quality.
5. Promoting Health Equity and Digital Innovation
5. Promoting Health Equity and Digital Innovation
CMS is aligning MIPS incentives with health equity initiatives, encouraging better care coordination and improved access for underserved populations. The expansion of digital health solutions is also a priority, pushing for greater interoperability and the adoption of advanced technologies, such as artificial intelligence, in healthcare. Clinicians are encouraged to engage in activities that promote health equity and to integrate innovative digital solutions into their practice workflows.
Next Steps for Clinicians:
- Review Updated Measures: Familiarize yourself with the new and retired quality measures to ensure compliance.
- Optimize EHR Systems: Ensure your EHR technology is updated and certified according to the latest CMS requirements.
- Focus on Cost Efficiency: Analyze practice patterns to identify opportunities for reducing unnecessary costs while maintaining quality care.
- Engage in Improvement Activities: Participate in CMS-designated improvement activities, especially those promoting health equity and digital innovation.
- Develop your Success Plan with MIPS in the 2025 Performance Year!
By proactively adapting to these MIPS 2025 updates, healthcare providers can enhance patient care, optimize operational efficiency, and secure favorable reimbursement outcomes.
Healthcare Innovation Solutions stands ready as your certified MIPS and MVPs partner. Schedule an introductory call here with one of our Quality Specialists or Contact Us today!