Value-Based Approach to MIPS: Improving Your MIPS Score

Written for AAOE by Joseph Mathews

This article is a precursor to my speaking session titled “Value-Based Approach to MIPS: Improving Your MIPS Score” at the upcoming AAOE 2024 conference.

Introduction

The “Merit-Based Incentive Payment System” (MIPS) has gotten more complex and costly, sometimes detracting us from patient care efforts. In this article, Ravi and I will unravel the complexities and show you how to navigate MIPS efficiently and cost-effectively. Our secret weapons? Selection and Automation! By strategically selecting and automating specific MIPS measures, your orthopedic practice can boost your MIPS score and sidestep penalties.

The MIPS Maze: A Brief Overview

What Is MIPS?

MIPS, which stands for Merit-based Incentive Payment System, is a program within the CMS’ Quality Payment Program (QPP). It determines Medicare payment adjustments for healthcare providers. The MIPS score is derived from measurements across four distinct categories and is assessed using a point-based system.

Why should you care?

If your MIPS score falls below 75 points, it results in a negative payment adjustment, while scoring above 75 leads to a positive payment adjustment. For an orthopedic provider with an annual revenue of $900K, a negative adjustment could roughly translate to $24K. It’s therefore essential for healthcare providers to understand and optimize their MIPS performance to ensure favorable financial outcomes.

Alternative to MIPS

Clinicians can become exempt from participating in MIPS if they become a qualified participant in an Advanced Alternative Payment Models (APMs) by taking added risks when treating their patients while delivering high-quality, coordinated, and efficient care. However, under the final 2024 PFS rules, the thresholds were raised significantly qualify as an APM provider. Additionally, unless an update is made, there are no more APM incentives in place for 2024.

Orthopedic Administrators: Caught in the Crossfire

As administrators, we constantly must juggle conflicting needs. Supporting the Medicare patient population which makes up a significant portion of your payor means more red tape, additional burden on staff, and therefore higher costs. Opting out, on the other hand is easier said than done. In the presentation we present a method to be compliant with MIPS requirements without having to add more unproductive staff hours.

Navigating the MIPS Storm: Our Approach

1. The Four MIPS Categories

Here is a quick rundown: (a) The Quality category assesses patient outcomes, safety, and effectiveness. (b) Promoting Interoperability or PI emphasizes technology adoption, including EHRs and patient engagement. (c) Improvement Activities or IA enhance patient care through activities like care coordination and education. (d) The Cost category evaluates care costs while minimizing unnecessary expenses.

2. Chart a Path to 75 Points

Chart your path to garnering more than 75 points by understanding the four categories, the point allocation for each, setting realistic targets for each, and work backwards from there. Try to maximize the points for IA (15 points) and PI (25 points) by relying on a good EMR that addresses most of the gaps and training staff to consistently perform close out steps such as helping close referral loops. CMS does not provide adequate or timely feedback on the Cost measure performance (30 points) and hence the final score is not entirely in your control. Be conservative and assume you will achieve half those points. What this means is that you must focus on maximizing the points for Quality (30 points) to get past the 75-point finish line comfortably. But you must do this in a cost-efficient manner; you don’t want to spend more than what you are actually saving.

3. Quality Measures: Benchmark-Based Selection

Imagine you’re at a buffet. Instead of piling your plate with everything, focus on the dishes you love. Similarly, we recommend cherry-picking MIPS measures based on benchmark scores. Identify the ones that align with your practice’s strengths and patient population.

4. The Automation Tango

Avoid labor-intensive workflows and manual data entry. Automated data collection, and integration into the EMR is key. Say goodbye to inefficiency and hello to streamlined processes. Make your solution cost effective. Utilize your most expensive resources (your staff) on what matters most: patient care.

Conclusion

MIPS need not be a daunting dragon. It is possible to achieve a good MIPS score, avoid a penalty without expending a lot of resources. I look forward to catching up and sharing experiences are at the AAOE conference.

Don’t miss this discussion at the 2024 AAOE Annual Conference. Value-Based Approach to MIPS: Improving Your MIPS Score is taking place on Sunday, April 28, 2024 from 8:30 am – 9:15 am CDT at the Hyatt Regency Chicago. Learn more at https://www.aaoeconference.com/.