Accountable Care Organizations are a valued part of the MIPS 2024 program of medicare CQMs. They play a key role in the alignment of financial incentives with value-based care. Therefore, they strive hard for quality improvement and patient-centered care. In the MIPS 2023 rule, CMS asked for All-Payer Quality Reporting from Medicare ACOs. Moreover, it allowed ACO to use three collection types for reporting quality measure data. These are CMS Web Interfaces, MIPS CQMs, and eCQMs. However, CMS has already terminated the Web interface for MIPS reporting medicare CQMs. Also, it has announced termination from ACOs as well onwards from 2025. This situation predicts new challenges for these ACOs in the future. Recently, we got the MIPS 2024 proposed rules. This MIPS 2024 rule proposes the creation of a new collection type, ‘Medicare CQMs, for ACOs. So, the ACOs that intend to appear in MIPS 2024 have good expectations from Medicare CQMs.
In this blog, we will uncover the details about the newly proposed Medicare CQMs. How are they going to make a difference in MIPS 2024? What’s more the MIPS 2024 proposed rule say about it? Let’s dive in and explore!
Medicare CQMs for Quality Data Reporting in MIPS 2024
It is essentially a new collection type for ACOs in the MIPS 2024 proposed rule. However, it is not much different from the MIPS CQMs. It allows eligible beneficiaries among Medicare ACOs to report a set of three quality measures.
For MIPS CQMs and eCQMs, ACOs can depend on a MIPS-qualified registry or other third-party vendors for data collection. Likewise, ACOs can deal with the Medicare CQMs in the same way. Thus, QPP MIPS, as a qualified registry, can collect and submit Medicare CQMs to CMS on their behalf.
What’s so Special About Medicare CQMs?
We have one simple and pronounced specialty about Medicare CQMs that makes them unique. They are not necessarily the same as MIPS CQM. However, unlike MIPS CQMs, we consider data from eligible ACOs Medicare fee-for-service beneficiaries only. On the contrary, for MIPS CQMs, we have an all-payer/all-patient population reporting rule for MIPS 2024 medicare CQMs.
Who will be an eligible beneficiary for Medicare CQMs in MIPS 2024?
As we know, eligible beneficiaries have a considerable role in MIPS 2024 ACO Reporting participation. You might be thinking, who are these ‘eligible beneficiaries’? Well, CMS has defined the eligibility criteria for ACOs Medicare beneficiaries as well. Here is the definition extracted from the MIPS 2024 proposed rule:
- Firstly, you must fulfill the key criteria to be a part of ACO. Second, you must ensure at least one claim during the measurement period from professionals like:
- Primary care physicians
- Specialists with any designated specialty (Neurology, Nephrology, Cardiology, Osteopathic manipulative medicine, Obstetrics/gynecology, Sports medicine, Physical medicine and rehabilitation, Psychiatry, Geriatric Psychiatry, Pulmonary disease, Endocrinology, Addiction Medicine, Hematology/Oncology, Hematology, Preventive medicine, Medical Oncology, Gynecology/oncology, or Neuropsychiatry)
- Multispecialty group practices
- Physician Assistant (PA) or/and Nurse Practitioner (NP)
- Clinical Nurse Specialist (CNS)
- Medicare beneficiaries assigned to an ACO designate an ACO professional as their care coordinator.
No worries, medicare CQMs is here to assist ACOs in enhancing health and lowering healthcare costs. Every year, they provide ACOs with a list of Medicare enrollees who are qualified for medicare CQMs. However, the list will be updated at the start of the quality data reporting period. The list will include essentially the information required for backing Medicare CQM reporting. For instance, the beneficiary’s unique identity, gender, birth and death dates (if relevant), the subgroup of patients with chronic conditions, and the NPIs of the top three ACO providers. Additionally, health status data may be included, making it simple to find patients who fit the Medicare CQM standards.
Despite CMS giving a list of ACO beneficiaries for medicare CQM reporting, this list won’t be comprehensive. It is simply due to an incomplete run-out on performance year claims data. Therefore, ACOs must take responsibility for themselves. They must ensure that all beneficiaries eligible for Medicare CQM specifications and the eligible beneficiary definition are included in the eligible population or denominator for reporting each Medicare CQM.
Quality Measures Allocated for Medicare Beneficiaries
The rule brought exciting news for ACOs applicable for the 2024 performance year! Medicare beneficiaries under APP using Medicare CQMs have 3 quality measures to report. Check out these quality measures given below:
| #1 | Diabetes: Hemoglobin A1c (HbA1c) Poor Control |
| #134 | Preventive Care and Screening: Screening for Depression and Follow-up Plan |
| #1=236 | Controlling High Blood Pressure |
Conclusion
CMS has high expectations for Medicare CQMs proposed in the MIPS 2024 proposed rule. This novel collection type will be taken as a transitional collection type. So, it will assist ACOs in working on their expertise for reporting all-payer/all-patient MIPS CQMs and eCQMs. They will be able to improve their infrastructure and skills accordingly.
That’s all about Medicare CQMs. For further information, keep following our blogs on MIPS reporting-related information. Also, place your feedback and queries below in the comment section. Our MIPS consulting services are available for your detailed guidance as well.
