If your practice accepts Medicare, participating in a Medicare Quality Payment Program (QPP) is an essential part of maximizing your reimbursements.
QPP participants are scored based on self-reported practice data. Those who score above the Centers for Medicare & Medicaid Services (CMS) quality threshold can increase their reimbursement rate by up to 9%, while those who score below the threshold decrease their rate by up to the same amount.
Traditionally, practices had two options: the Merit-based Incentive Payment System (MIPS) or Alternative Payment Models (APMs). The extensive reporting requirements of those systems are unmanageable for many small practices.
Kitty Arp, office manager at Dermatology Associates of West Texas, said without the help of a MIPS consultant, it was all her staff could do to meet the threshold, never mind exceeding it.
“We were working so hard just to avoid MIPS penalties and keep our score neutral,” she said. “We weren’t even expecting to receive bonuses; we just didn’t want to lose money to penalties.”
In 2023, CMS created MIPS Value Pathways (MVPs) to meet the needs of small and specialty practices. MVPs track data in the same categories as MIPS, but practices report on fewer measures.
In addition, MVP reporting measures have subsets that consider medical specialty, patient population, and public health priorities. This allows small and specialty practices to focus on collecting data that’s actually meaningful to their business.
How Do MIPS Value Pathways Work?
There are five steps your practice will go through with its MVP, from registering through getting performance feedback from CMS.
Step 1: Registration
To report an MVP next year, your practice must register between April 1 and December 1 of this year. Registration is done online. There is a step-by-step guide to walk participants through the process.
If you register an MVP, then later change your mind and decide you’d rather report through traditional MIPS or an APM, you can make the switch with no penalty.
Step 2: Data Collection
When you register, you will choose the MVP you want to report. Each MVP has associated population health measures; you will choose one associated with your chosen MVP.
Throughout the calendar year, you will collect the data required by your MVP. Like MIPS, you will be scored on quality, improvement activities, promoting interoperability, and cost reporting.
Step 3: Reporting
Clinicians can report as individuals using their National Provider Identifier (NPI) or as a group using the business’s Tax Identification Number (TIN). A group is defined as two or more NPIs sharing a TIN.
Clinicians who are reporting as part of a group may also report as an individual if they wish.
Starting in 2026, multispecialty practices will be required to report subgroups of clinicians in each specialty.
Each individual, subgroup, or group will report on:
- Four quality measures, including at least one “outcome” or “high priority” measure
- One improvement activities measure
- Whether or not they use an EHR that allows electronic exchange of health data with providers outside the practice
Step 4: Scoring
Once your report has been received, CMS uses administrative claims to calculate your cost reporting data and to calculate your performance on the population health measure you chose.
Your total score is weighted:
- 30% on quality
- 15% on improvement activities
- 25% on promoting interoperability (defined as having an interoperable EHR)
- 30% on cost
Step 5: Performance Feedback
When you receive your score and your new reimbursement rate, you will also get feedback on your practice’s performance.
The feedback compares your performance against similar clinicians who reported using the same MIPS Value Pathway. Ideally, this feedback offers constructive feedback you can use to strengthen your practice.
When Are MIPS Value Pathways a Good Fit for Practices?
Both MIPS and MVPs determine Medicare Part B payment adjustments. If your practice bills Medicare, you can increase your reimbursement rate by up to 9% by participating in one and meeting its requirements.
If your practice has struggled in the past to stay on top of MIPS reporting, switching to an MVP may make it easier. The lighter administrative load can reduce the costs of reporting, improve your chance of bonuses, and reduce your risk of penalties.
MVPs may also be a good fit if one of the 21 pathways aligns with what you do in your practice. Since you have to collect data for reporting anyway, it may as well be data you can also use to further your practice goals.
Advantages of MIPS Value Pathways for Medical Practices
When compared to traditional MIPS, MIPS Value Pathways offer a couple of advantages.
MVPs Require Less Data Than MIPS
Small practices may not be able to dedicate a staffer to collecting MIPS data. Recognizing that practice administrators are already wearing many hats, CMS developed MVPs to lighten the burden.
Each MVP has a fixed set of data requirements, so administrators don’t have to sift through a long list to decide which data is most relevant to their practice. In addition, MVPs require practices to report on three to five fewer measures than MIPS.
Both MIPS and MVPs make special allowances for solo practitioners and practices with fewer than 10 clinicians:
- Categories are reweighted for small practices
- Small practices are not required to meet case minimums
- Small practices are not required to meet data completeness requirements
- Small practices are allowed to report quality measures without a benchmark
In addition, multiple small practices can band together and form a virtual group for the purpose of reporting.
MVPs Are Specialty Specific
MIPS Value Pathways have specialty-specific reporting options. This allows specialty clinicians to collect and report on data that’s relevant and significant to their practice.
This makes MVPs an attractive option for specialists including dermatologists, ophthalmologists, and orthopedists.
MVP specialties also include categories for nonphysician clinicians such as nurse practitioners and physician assistants.
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MIPS Value Pathways Might Not Be a Fit for Every Specialty Practice
One of the problems specialty practices have with traditional MIPS is that there are so many options to choose from. This can make reporting overwhelming and needlessly complex.
When creating MVPs, CMS tried to remedy that problem by assigning a fixed set of measures to each MIPS Value Pathway.
This simplifies reporting as long as there’s an MVP that’s aligned with your practice. But if none of the existing MVPs apply, you might be better off sticking with MIPS and hand-picking reporting measures that reflect the reality of your practice.
The End of Traditional MIPS
Though it hasn’t set a date, CMS has made it clear that traditional MIPS will sunset at some point and be completely replaced by MIPS Value Pathways.
Right now, the target date for that transition is 2030, though it could change. Whether your practice decides to switch to MVPs now or later, it’s wise to remember you will have to make the switch eventually.
Reporting Tip: Automate Data Collection With Your EHR
Whether your practice participates in traditional MIPS or a MIPS Value Pathway, your electronic health record (EHR) can streamline collection of the data you need.
Once you’ve decided what data you are going to report, you can set up your EHR to automatically record and aggregate the relevant information.
When California LASIK & Eye implemented their ophthalmology-specific EHR, they set it up to collect MIPS data automatically, allowing clinicians to focus on the patient.
“I’m not thinking, ‘I’m going to click this box for MIPS,’” Dr. Brad Barnett said. “You have peace of mind knowing you are compliant and you can focus on the patient and on providing the care you need to provide.”
Automating data collection throughout the year makes reporting smooth and eliminates the need to sift through a mountain of data at the end of the year.
The Dos and Don’ts Reporting with MIPS Value Pathways
To get the best results from your MVP, follow these best practices and avoid these common mistakes.
Do Follow These Best Practices
- Choose a value pathway that makes sense for your practice. This year, there are 21 MVPs to choose from.
- Plan ahead. Before the reporting year begins, get everyone on your team familiar with the MVP framework and any responsibilities it places on them.
- Set up your EHR to collect relevant data. Have a consultation with a MIPS expert to make sure you are set up for success.
- Integrate MVP reporting into your routine workflows. When it’s just another step in processing patient paperwork, it’s more likely you’ll reach the end of the year with complete information.
- Keep the spirit of QPP regulations in mind. MVPs are intended to help practices deliver quality care. Instead of viewing it as just another regulatory burden, look for ways you can integrate your MVP into your routine and better serve patients at the same time.
Don’t Make These Common Mistakes
- Failing to stay up to date on MVP changes. CMS updates all QPP programs annually. The measures you reported on last year might not even be available to report on this year. Instead of just repeating what you did last year, review the latest changes.
- Reporting incorrect information. Data entry errors are a simple but fatal reporting flaw for many practices. Collecting and reporting the wrong data can cause you to miss out on bonuses you earned or pay penalties you don’t deserve. Use a certified EHR with automated data capture to minimize manual data entry.
- Ignoring performance feedback. Whether or not you believe QPP programs are a good way to improve the quality of healthcare, that is their intent. Review feedback with an open mind and an approach toward continuous improvement in your practice.
Nextech Eases the Burden of Quality Reporting
Running a successful healthcare practice is no small feat. On top of the exhaustive task list every business bears, medical practices have to juggle government requirements, work with insurers, and manage patient care.
MIPS Value Pathways make reporting for Medicare reimbursement easier for small and specialty practices, helping them maximize their reimbursement rate while providing quality care.
Nextech’s specialty-specific platform with EHR and practice management technology streamlines data collection and reporting, taking the administrative burden out of MVP reporting. And Nextech’s dedicated team of MIPS consultants is available to provide expert guidance.
Request a demo to see how Nextech can make your reporting easier.
MIPS Value Pathways FAQs
What’s the difference between MIPS and MVPs?
Both MIPS and MVPs collect similar data, which they weigh and score the same way. The biggest difference is that MIPS provides a tremendous number of reporting options to choose from, while MVPs present a lean selection of predetermined reporting tracks based on specialty and type of care. Participants in MVPs also report on a smaller number of measures than participants in MIPS.
What are the disadvantages of MIPS MVPs?
Though MVPs are easier to report than MIPS, they still create an administrative burden. A practice has to register their reporting track, then collect and document extensive data throughout the year for a final report.
Because MIPS and MVPs use a combination of self-reported measures, national benchmarks, and administrative claims data, it can be hard for a practice to predict where their performance will land at the end of the year.
Despite the aim to improve value, MVPs still rely heavily on easily measurable process-based measures rather than meaningful patient outcomes, incentivizing compliance over improvement.
Why is MIPS so important?
To an individual practice that bills Medicare Part B, MIPS matters because it directly impacts the bottom line. Not participating in MIPS or one of its alternatives means being docked on your reimbursement rate for Medicare Part B by up to 9%. This can add up to tens of thousands of dollars.
About the Author
Heather Miller has more than 25 years of leadership experience in healthcare operational management, providing comprehensive medical consultation to hundreds of practices. Her expertise includes oversight of revenue cycle management, Medicaid and Medicare compliance, and workflow analysis to increase practice productivity. She has a proven track record in supporting clients in the adoption of electronic health records and providing strategy plans for annual MIPS reporting.
Heather holds a master’s degree in business administration from Rollins College - Crummer School of Business and a second master’s degree in Early Childhood Special Education from the University of Miami. She completed her undergraduate degree at the University of Tennessee in Special Education.