Transforming MIPS: Moving Beyond Criticism

Shifting Focus to Implementation

The debate over whether the Centers for Medicare and Medicaid Services (CMS) needs to enhance the Merit-based Incentive Payment System (MIPS) is no longer relevant. The emphasis has now shifted to developing practical strategies that genuinely fulfill the promise of a better healthcare system. It is important to recognize that no quality payment program has achieved perfection during its initial years. The launch and real-time testing of such programs provide valuable insights into their actual performance and effectiveness, as seen with MIPS since its inception in 2017. Physicians have raised concerns regarding this payment model, prompting leading healthcare organizations to propose solutions to address MIPS-related challenges.

Reducing Administrative Burdens

A significant amount of administrative work is associated with MIPS reporting, which involves extensive data collection to submit to CMS. This burden stems from the inclusion of primary care and value-based medical services within quality measures. Simplifying MIPS could enhance its appeal to clinicians by alleviating the strain of administrative tasks. MIPS integrates components from three primary programs:

– Physician Quality Reporting System (PQRS)
– Value-Based Payment Modifier (VM)
– Meaningful Use (MU)

CMS is working to streamline these elements, yet many clinicians still express dissatisfaction due to ongoing administrative challenges in quality reporting. Furthermore, numerous physicians question the relevance of MIPS quality measures, particularly surgeons who feel the focus on patient immunizations is inappropriate for their specialty.

Recommendations from Medical Leaders

David O. Barde, former president of the American Medical Association (AMA), has offered several recommendations to improve MIPS:

– Decrease the number of measures a physician is required to report.
– Expand the definition of a facility in MIPS reporting to encompass all healthcare service providers, regardless of location, including post-acute care centers.
– Establish a 90-day performance period for all MIPS measures, allowing physicians to concentrate on patient care.

Reassessing the Promoting Interoperability Category

The Promoting Interoperability (PI) category, previously known as Advancing Care Information (ACI), often tests physicians’ patience. This category aims to encourage the use of certified electronic health record (EHR) technology. However, many physicians feel that the focus on EHR technology detracts from genuine advancements in the healthcare system. To align the PI category more closely with its intended purpose, the emphasis should shift towards the practical use of technology and the translation of digital health information to benefit patients. Adjustments to reporting requirements are necessary to enhance the utility of this category for physicians.

Positive Developments in MIPS 2019

In 2019, changes were implemented within the PI category aimed at improving overall performance. To excel in this category, physicians must focus on specific areas:

– E-Prescribing: Utilizing computerized systems for generating, transmitting, and filling prescriptions.
– Secure Health Information Exchange: Ensuring safe and efficient sharing of health data.
– Patient Access: Facilitating easy access to healthcare information for patients.
– Public Health and Clinical Data Exchange: Promoting data sharing among various healthcare stakeholders.

Physicians need not invest significant resources to excel in these categories; even minor improvements can yield substantial gains in their MIPS scores.

Leveraging the “Opt-In” Policy

MIPS holds significant potential to advance the healthcare industry. However, with the implementation of the Quality Payment Program (QPP) final rule for MIPS 2019, approximately 58% of physicians are excluded from participation. Fortunately, the introduction of the “Opt-In” policy allows those outside the MACRA and MIPS framework to engage in the program and earn rewards as if they were eligible.

CMS has revised reporting requirements, aiming to reduce physician burnout and offering more manageable expectations. The program’s flexibility benefits smaller medical practices with limited resources by simplifying their reporting obligations compared to larger practices, maximizing their potential benefits from MIPS 2019. This policy encourages physicians to advocate for value-based care.

Looking Ahead: MIPS 2020 and Patient Portals

As MIPS 2020 becomes mandatory for physicians to ensure quality care and cost efficiency, the significance of patient portals is increasingly emphasized. An upcoming article will delve into this topic for our audience. For further insights, readers can explore our piece on MIPS Quality Measures 2019 vs. 2020 – Registry Investigates.