CMS Unveils Five New Efficiency Models

The proposed cost-efficiency models are slated for the CY 2023 MIPS.

The Centers for Medicare & Medicaid Services (CMS) is asking for feedback from stakeholders on five proposed cost-efficiency models as part of the Merit-Based Incentive Payment System (MIPS) program. The deadline to respond is March 25, 2022.

According to CMS, the proposed cost-efficiency models for the 2023 version of MIPS center on specialty professionals such as emergency physicians, psychiatrists, and cardiologists/hospitalists.  

James S. Kennedy, MD, who has studied the proposal from CMS, said the implementation of the cost-efficiency models would apply to emergency room/observation visits, inpatient heart failure care, and lower back pain inpatient psychiatric care, all to be effective Jan. 1, 2023.

Kennedy, in an email to ICD10monitor, said the models were authorized by the Medicare and CHIP (Children’s Health Insurance Program) Reauthorization Act of 2015 (MACRA); clinical documentation improvement (CDI) teams now will surely have a role in ensuring that providers can avoid physician financial penalties of up to 2.7 percent.  

According to Kennedy, the initiative is part of the CMS strategy to promote risk-adjusted cost efficiency among all providers. Kennedy said stakeholders that will be affected by these models are encouraged to submit comments at soon as possible. Currently, the episode-based cost measures that are being field-tested include the aforementioned emergency medicine, heart failure, lower back pain, major depressive disorder and psychoses/related conditions.

Clinicians and clinician groups who meet the attribution requirements for at least one of the measures will receive a field test report. All stakeholders are invited to provide feedback on the draft measure specifications through an online survey (https://lnkd.in/d68Pa4vR). Participation is voluntary.

Kennedy said clinicians or their groups can download their field test report(s) via https://qpp.cms.gov/login; such reports are issued if they have at least 20 episodes for at least one of the measures. Field test reports contain information about cost performance based on draft measure specifications. This information will be for field testing purposes only. The measurement period for these field test reports is Jan. 1 to Dec. 31, 2019.

 
Reference resources on the MACRA Feedback Page to help inform your feedback, such as draft measure specifications documentation and excerpted measure-specific questions from the online survey at the following website: https://lnkd.in/den59aXr.

Kennedy also said physicians can watch a CMS-sanctioned webinar on the Cost Measures Field Testing Presentation to learn more.  

The recording is available at https://lnkd.in/dgQhXACZ. The presentation provides the following information:

• Information about the five episode-based cost measures undergoing field testing;
• Project background, measure development process, and field-testing activities; and
• Discussion of the content of the field test reports, how to access and interpret these reports, and information on the supplemental documentation posted on the MACRA Feedback Page.

Kennedy, a member of the ICD10monitor editorial board and founder of CDIMD of Nashville, Tenn., is scheduled to be the special guest today during Talk Ten Tuesdays, which airs live at 10 a.m. EST.

Programming Note: Listen to Chuck Buck every Tuesday when he hosts Talk Ten Tuesdays, 10 a.m. Eastern.