In an advocacy win, CMS is proposing to keep the penalty threshold at 75 points (rather than the previously considered 82 points) due to significant feedback related to the complexity and challenges of the MIPS program.
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ACEP Now: Vol 43 – No 10 – October 2024MIPS Value Pathways
2025 is the third year in which a new reporting option in MIPS called MIPS Value Pathways (MVPs) is available. MVPs represent an approach that will allow clinicians to report on a more clinically integrated set of quality measures built around a specific emergency medicine episode or acute care condition. ACEP developed an emergency medicine-focused MVP that became available in 2024. The ACEP MVP is called “Adopting Best Practices and Promoting Patient Safety within Emergency Medicine.” More information about the MVP is available here.
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ED Continued Traction with Telehealth Services
CMS has been continually examining which codes placed on the list of approved Medicare telehealth services during the COVID-19 public health emergency should be continued. The current CMS process involves a list of “provisionally” approved codes, which include 99281-99285. The 2025 Proposed Rule is silent to the issue of sunsetting the ED codes, so they are likely to remain provisionally approved for telemedicine for 2025.
For more information regarding pressing ED reimbursement issues, attend the ACEP Reimbursement and Coding Conference in Orlando, Fla., January 20-22, 2025.
Dr. Granovsky is president of LogixHealth, an ED coding and billing company, and currently serves as the course director of ACEP’s Coding and Reimbursement courses. He may be reached at mgranovsky@logixhealth.com.
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One Response to “2025 Physician Reimbursement Update”
October 20, 2024
Stephen EpsteinA couple of the finer details (though Dr. Granovsky is the real expert here) –
First, the MIPS Value Pathway for emergency medicine includes the “foundation layer” in which an EM group must choose a population health measure. The choice is between hospital-wide, 30-day, all-cause unplanned readmission rate or risk-standardized hospital admission rates for patients with multiple chronic conditions. Neither is a particularly good option.
Second, the emergency medicine cost measure will be used for the first time this year and will comprise 30% of the overall MIPS score. While this new measure field-tested well, it throws another unknown into a group’s ability to predict how they will ultimately score on MIPS.
Third, ACEP isn’t going alone on the advocacy front – the AMA has made a big push for an annual inflationary update to the physician fee schedule. Together, those efforts have led to a majority of the House of Representatives requesting action: https://www.documentcloud.org/documents/25210928-physician-fee-schedule-letter.
Finally, we are awaiting the publication of the latest RAND study on the value of emergency medicine, which might also be beneficial in ACEP’s advocacy efforts for fair payment.