AASM analysis of the 2025 Quality Payment Program final rule

The Facilities for Medicare & Medicaid Providers (CMS) has posted the 2025 High quality Fee Program closing rule. An evaluation of the rule, together with key highlights particular to sleep medication, is offered under. CMS has finalized the next for 2025:

High quality Efficiency Class

Finalized a complete of 195 high quality measures

Addition of seven high quality measures
Removing of 10 high quality measures

Vital revisions to 66 high quality measures

*Certified Scientific Knowledge Registry (QCDR) measures are usually not part of this finalized measure depend.

Advantage-based Incentive Fee System (MIPS) Worth Pathways (MVPs)

21 whole MVPs

New:

Full Ophthalmologic Care MVP
Dermatological Care MVP
Gastroenterology Care MVP
Optimum Look after Sufferers with Urologic Situations MVP
Pulmonology Care MVP*
Surgical Care MVP

Modified:

Adopting Finest Practices and Selling Affected person Security inside Emergency Medication MVP
Advancing Most cancers Care MVP
Advancing Look after Coronary heart Illness MVP
Advancing Rheumatology Affected person Care MVP
Coordinating Stroke Care to Promote Prevention and Domesticate Optimistic Outcomes MVP
Specializing in Ladies’s Well being MVP
Bettering Look after Decrease Extremity Joint Restore MVP
Optimum Look after Kidney Well being MVP
Affected person Security and Help of Optimistic Experiences with Anesthesia MVP
Prevention and Therapy of Infectious Problems Together with Hepatitis C and HIV MVP
High quality Look after Sufferers with Neurological Situations MVP (CMS is modifying the beforehand finalized Optimum Look after Sufferers with Episodic Neurological Situations and the Supportive Look after Neurodegenerative Situations MVPs right into a single consolidated neurological MVP titled High quality Look after Sufferers with Neurological Situations.)
High quality Look after the Therapy of Ear, Nostril, and Throat Problems MVP
High quality Care in Psychological Well being and Substance Use Problems MVP
Rehabilitative Help for Musculoskeletal Care MVP
Worth in Main Care MVP

*Because the measure steward of measures Q277 (Sleep Apnea: Severity Evaluation at Preliminary Prognosis) and Q279 (Sleep Apnea: Evaluation of Adherence to Obstructive Sleep Apnea (OSA) remedy), the AASM strongly advocated for the inclusion of those measures together with all different proposed high quality measures and enchancment actions within the Pulmonology Care MVP to boost look after pulmonology sufferers. We strongly encourage our members to submit this MVP.

MIPS Fee Changes

The efficiency threshold will stay at 75 factors for the 2025 efficiency interval/2027 MIPS fee yr.

Knowledge Completeness

The 75% knowledge completeness threshold will stay by means of the 2028 efficiency interval/2023 MIPS fee yr.

Superior Different Fee Fashions (APMs)

CMS established the APP Plus high quality measure set as a second measure set distinct from the present APP high quality measure set.

There will probably be six measures out there within the APP Plus high quality measure set within the 2025 efficiency interval, eight measures within the 2026 efficiency interval, 9 measures within the 2027 efficiency interval, and 11 measures no prior to the 2028 efficiency interval.

MIPS eligible clinicians, teams, or APM entities that report the APP might select to report both the APP high quality measure set or the APP Plus high quality measure set.

Members might ship questions relating to modifications to the High quality Fee Program to registry@aasm.org.