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.
Very little has changed this year for Hospital Medicine physicians and groups. Overall, these are the key updates and announcements you must know for 2025.
MIPS 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. Although there were many changes in 2025 that impacted other specialties, the list remains unchanged for Hospital Medicine and includes just four measures:
- #5 – Heart failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin receptor Blocker (ARB) or Angiotensin Receptor Neprilysin Inhibitor (ARNI) Therapy for Left Ventricular Systolic Dysfunction (LVSD)
- #8 – Heart Failure (HF): Beta Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)
- #4 – Advance Care Plan
- #130 – Documentation of Current Medications in the Medical Record
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 Merit-based Incentive Payment System Value Pathways program, introducing six new MVPs for 2025: Ophthalmology, Dermatology, Gastroenterology, Pulmonology, Urology, and Surgical Care.
While there is no Hospitalist MVP at this time, there are disease-specific MVPs that hospitalists and groups may select to report on. Your reporting partner can help you evaluate and select your best options.
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. Hospital 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 tracking, Ventra encourages groups to think beyond MIPS, because data collected for MIPS reporting can also be leveraged with 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 individual hospitalists and groups to take control of their quality outcomes and build stronger relationships with key stakeholders.
