MIPS Value Pathways: What You Need to Know

The Centers for Medicare & Medicaid Services (CMS) revealed a new MIPS Value Pathways (MVPs) program as part of recent proposed rules. The program is designed to help unsilo and build alignment across performance category scores and reporting. As a result, the overall MVPs process may become less burdensome to manage and more relevant to specialty providers than initial MIPS processes and may support improved patient outcomes at lower costs.

Participation is optional for 2023 through 2025 and requires registration and selection of one of seven current value pathways, although the scope of pathways may change in the future. Reporting requirements include the same four performance categories that MIPS has always included, but with redistributed weights, plus a foundational layer of promoting interoperability and population health measures. With MVPs, you’ll likely have fewer measures to report, and many are speciality-specific. For example, for orthopedics you have only seven quality measures to choose from (you pick four) and 11 improvement activities (you choose one high or two medium).

Here, ModMed^® provides an overview of how MVPS may impact your practice and how you can begin to prepare for the future of value-based care today.

What Are MIPS Value Pathways (MVPs)?

MIPS Value Pathways (MVPs) are an updated set of measures and activities that physicians and clinics can follow to satisfy MIPS reporting requirements.

The MVPs program includes a few key changes:

• The four MIPS performance categories —- quality, cost, interoperability and improvement activities — still apply, but the value of each category has shifted.
• Quality, cost and improvement activities are scored at the MVP level, meaning your practice would choose measures from a CMS list related to your value pathway.
• Interoperability remains specialty-agnostic.
• Population health measures are also part of a foundational, specialty-agnostic layer. Practices may choose one measure to score.
• Multispecialty groups may divide into subgroups, submitting population health and interoperability data at the group level and quality, cost and improvement activity data at the sub-group level.

These changes are intended to contribute to a larger evolution in approach. Under MVPs, quality measures must be reported in relation to cost and improvement measures. This is designed to help ensure scoring represents a meaningful and cohesive picture of a clinic’s performance.

The Evolution of MIPS Values

MIPS was created to help shift incentives away from fee-for-service payment models and towards higher quality care at a lower cost.

Within the MVP framework, CMS intends to create tighter alignment between measures and activities for different specialties or conditions. By considering population health and interoperability as foundational to the evolution of healthcare, MVPs may be able to promote the objectives of the industry as a whole, while ensuring the differences in specialty-specific care don’t fall between the cracks.

The inclusion of technology solutions to achieve these ends helps build visibility and efficiencies in cost and care.  The focus on specialty-specific priorities and workflows within ModMed’s EMA^® EHR and  gGastro^® EHR can further these efficiencies:

• Centralized patient records make it easier for patients, providers and third-party partners to access data when they need it.
• Purpose-built workflows may speed documentation with fewer clicks and taps for providers, helping to support accuracy and return physician focus to the patient.
• Automation helps perform many downstream tasks and helps to promote consistency of data across workflows.

Practices that optimize solutions may also experience other benefits, like improved patient engagement, reduction of administrative burdens on clinic staff and attracting new providers to your practice to support growth.

New Value Pathways

In keeping with CMS’ renewed focus on specialty-specific measures, new MIPS value pathways have been developed. There are 12 MVPs available for voluntary reporting in 2023:

1.  Adopting Best Practices and Promoting Patient Safety within Emergency Medicine
2. Advancing Care for Heart Disease
3. Advancing Rheumatology Patient Care
4. Coordinating Stroke Care to Promote Prevention and Cultivate Positive Outcomes
5. Improving Care for Lower Extremity Joint Repair
6. Optimizing Chronic Disease Management
7. Patient Safety and Support of Positive Experiences with Anesthesia
8. Advancing Cancer Care
9. Optimal Care for Kidney Health
10. Optimal Care for Patients with Episodic Neurological Conditions
11. Supportive Care for Neurodegenerative Conditions
12. Promoting Wellness

CMS has also identified how it will develop candidates for new value pathways. These guidelines mirror the components of current MVPs. Among other guidelines, each candidate must be characterized by limited, connected and complementary sets of meaningful measures and activities, featuring comparative performance data to help evaluate clinician performance and patient choices about their care.

Are MIPS Value Pathways Required?

Eventually, MIPS Value Pathways will be required as part of the transition to value-based care standards. The transition will be gradual with MVPs rolling out for the 2023 performance year and remaining voluntary in 2023, 2024 and 2025.

This transition also represents the phasing out of the traditional MIPS program, which CMS plans to sunset by 2027. Once the transition is complete, practices may experience another significant shift in how they collect, track and report their performance data.

Preparing for MIPS Value Pathways

Physicians that underwent the transition to MIPs processes may recognize the value in preparing for MVPs now. Any change in rules and reporting may present a challenge to your business and its bottom line. With advance preparation, you may be able to mitigate the risks of transitioning to new value pathways and maintain continuity in your practice’s day-to-day operations.

At ModMed, we will begin to support the rheumatology and orthopedic MVPs measures within our EMA EHR. As additional measures are finalized, our teams will assess them and make them available in EMA and gGastro EHRs, when appropriate.

If you need additional MIPS support, we encourage our clients to take advantage of our MIPS advisory programs. With our MIPS Advisory Service options for EMA and gGastro clients, you’ll get a MIPS Advisor who knows both your EMR and your practice. They’ll monitor your performance and work with you to achieve your goals.

We’d also like to encourage you to attend our upcoming MIPS webinars. If you are a current client you can check ModMed Communities for additional MIPS resources and we’ll be sending new communications as more information becomes available.

Need help with MIPS? Check out our solutions for ModMed’s EMA and gGastro clients.