The Centers for Medicare and Medicaid Services (CMS) recently released the final rule for the 2025 Quality Payment Program (QPP). This rule outlines the participation of clinicians and groups in the Merit-based Incentive Payment System (MIPS), Alternative Payment Models, and other Quality Payment Program features during the 2025 performance year with a 2027 payment year.
CMS finalized proposed changes this year that will unfortunately make it a little more difficult for Emergency physicians and groups to be successful with MIPS reporting. After steady improvement in previous years, some Quality measures have now been topped out or eliminated, and new measures have been added. The changes may bring scores down this year for Emergency Medicine.
Overall, these are the key updates and announcements you must know for 2025.
MIPS Emergency Medicine Thresholds and Category Weighting
- The MIPS performance threshold will remain at 75 points through CY 2027.
- The data completeness threshold remains at 75% for the MIPS Quality Performance Category through the CY 2028 performance period, possibly rising to 80% in CY 2029.
- There were no overall changes to the 2025 weighting of the four reporting categories: Quality, Improvement Activities, Cost, and Promoting Interoperability. However, qualifying for Special Status (small, non-patient facing, etc.) will continue to affect the weighting of categories for individuals or groups. Check your Special Status when it becomes available in December 2025 to see what may be re-weighted.
Quality Category Updates
CMS re-evaluates the list of Quality measures annually. The 2025 list includes the following changes that will impact Emergency Medicine.
Quality Measure Changes:
Measure Retired:
- #254 – Ultrasound Determination of Pregnancy Location for Pregnant Patients with Abdominal Pain
MIPS Emergency Medicine MIPS Value Pathway (MVP) Changes:
Measure Retired:
- #254 – Ultrasound Determination of Pregnancy Location for Pregnant Patients with Abdominal Pain
Improvement Activity Added:
- IA_PM_26 – Vaccine Achievement for Practice Staff: COVID-19, Influenza, and Hepatitis B
Population Health (PH) Measure Changes:
Physicians and groups formerly had to choose one of the following two measures:
- ID 479: Hospital-Wide, 30-Day, All-Cause Unplanned Readmission
- ID 484: Clinician and Clinician Group Risk-standardized Hospital Admission Rates for Patients w/ Multiple Chronic Conditions
CMS will now calculate both PH measures and apply the highest scoring measure to the overall score.
MIPS Emergency Medicine Measure Set Changes:
Measures Removed:
- #254 – Ultrasound Determination of Pregnancy Location for Pregnant Patients with Abdominal Pain
- #134 – Preventive Care and Screening: Screening for Depression and Follow-Up Plan
Measure Added:
- #181 – Elder Maltreatment Screen and Follow-Up Plan: Percentage of patients aged 60 years and older with a documented elder maltreatment screen using an Elder Maltreatment Screening tool on the date of encounter AND a documented follow-up plan on the date of the positive screen
Cost Category Update
CMS modified the scoring methodology starting in 2024 to increase points awarded in the Cost category. The median performance score will receive 7.5 points. Points are awarded based on standard deviation from the median performance. Under this new methodology, CMS anticipates an additional 3.89 points in the Cost performance category for clinicians with at least one Cost measure.
Promoting Interoperability
PI is voluntary for most hospital-based physicians and groups, and their categories are automatically re-weighted to omit PI. However, PI scores are typically high and can offset lower Quality measures when contributed toward your final score. We recommend contacting hospital IT to request a PI report for 2025, ideally by September 2025.
MIPS Value Pathways (MVPs)
CMS remains committed to the MIPS Value Pathways program, introducing six new MVPs for 2025: Ophthalmology, Dermatology, Gastroenterology, Pulmonology, Urology, and Surgical Care.
Physician Fee Schedule
For 2025, the conversion factor (CF) is set at $32.3465, marking a 2.83% decrease from the 2024 CF of $33.2875. This decrease resulted from a temporary update that expired at the end of 2024. The impact of the conversion factor rate may vary based on a practice’s procedural charge volumes, site of service, modality charge mix, and practice-specific billing arrangements. Emergency Medicine groups need to consider the potential financial implications of this change and adjust their budgets accordingly.
Beyond MIPS
When it comes to quality outcomes reporting, Ventra encourages groups to think beyond MIPS, because data collected for MIPS reporting can also be leveraged with your facilities and payers. Quality outcomes can be used for value-based care contracts, as well as credentialing and licensing. Groups with strong QI programs are also likely to improve their professional satisfaction and increase their appeal to potential hires. This approach to QI empowers Emergency Medicine physician groups to take control of their quality outcomes and build stronger relationships with key stakeholders.
